Healthcare Provider Details

I. General information

NPI: 1255460820
Provider Name (Legal Business Name): WAYNE COPELAND CROOKS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 E R L THORNTON FWY SUITE 503
DALLAS TX
75228-7018
US

IV. Provider business mailing address

8035 E R L THORNTON FWY SUITE 503
DALLAS TX
75228-7018
US

V. Phone/Fax

Practice location:
  • Phone: 214-319-9200
  • Fax: 214-319-9209
Mailing address:
  • Phone: 214-319-9200
  • Fax: 214-319-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27423
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: