Provider Demographics
NPI:1033406624
Name:AUFORTH, FREDERIC CORTLANDT III (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:FREDERIC
Middle Name:CORTLANDT
Last Name:AUFORTH
Suffix:III
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 NOLEN CT
Mailing Address - Street 2:APT. A
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-5945
Mailing Address - Country:US
Mailing Address - Phone:817-795-7151
Mailing Address - Fax:
Practice Address - Street 1:1904 NOLEN CT
Practice Address - Street 2:APT. A
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-5945
Practice Address - Country:US
Practice Address - Phone:817-795-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional