Individual
VANZANELL EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ADMINISTOR
Contact information
Practice address
7801 MARLBOROUGH DR W, FORT WORTH, TX 76134-4309
(817) 568-1445
(817) 782-9304
Mailing address
7801 MARLBOROUGH DR W, FORT WORTH, TX 76134-4309
(817) 568-1445
(817) 782-9304
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
136989
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75-2645166
ADMINISTOR
TX
05
—
75-2645166
—
TX
Enumeration date
11/24/2013
Last updated
11/24/2013
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