Provider Demographics
NPI:1174221618
Name:SAWYERS, JAY KIRKLYN
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:KIRKLYN
Last Name:SAWYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 KEATING ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6163
Mailing Address - Country:US
Mailing Address - Phone:903-818-4480
Mailing Address - Fax:
Practice Address - Street 1:5025 KEATING ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6163
Practice Address - Country:US
Practice Address - Phone:903-818-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional