Provider Demographics
NPI:1346088283
Name:KLINTWORTH, STEFANIE (LCSW)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:KLINTWORTH
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 1:9004 QUARRY HILL CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-2955
Mailing Address - Country:US
Mailing Address - Phone:703-232-0253
Mailing Address - Fax:
Practice Address - Street 1:4232 HERITAGE TRACE PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5375
Practice Address - Country:US
Practice Address - Phone:817-447-3001
Practice Address - Fax:817-898-3327
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty