Organization
HOME OF LIFE JOURNEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARIAN DENISE WALTERS MSW (OWNER/PROGRAM MANAGER)
(817) 769-0379
Entity
Organization
Contact information
Practice address
4228 HARDEMAN ST, FT WORTH, TX 76119-3870
(817) 769-0379
Mailing address
4228 HARDEMAN ST, FORT WORTH, TX 76119-3870
(817) 769-0379
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
05/09/2012
Last updated
05/09/2012
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