Provider Demographics
NPI:1063492171
Name:SAUNDERS, JUDITH MICHELE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MICHELE
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 HEMPHILL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110
Mailing Address - Country:US
Mailing Address - Phone:817-927-4040
Mailing Address - Fax:817-924-2562
Practice Address - Street 1:1723 HEMPHILL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110
Practice Address - Country:US
Practice Address - Phone:817-927-4040
Practice Address - Fax:817-924-2562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26971104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1671232Medicaid
TX1671232Medicaid