Provider Demographics
NPI:1659772234
Name:BALLINGER SIMPSON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BALLINGER SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W VICKERY BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6256
Mailing Address - Country:US
Mailing Address - Phone:817-683-0263
Mailing Address - Fax:
Practice Address - Street 1:6300 RAINBOW TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-5336
Practice Address - Country:US
Practice Address - Phone:817-266-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX517721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical