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General NPI Number Information
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NPI Number | 1003002593
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Entity Type | Organization
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Legal Business Name | CLINICAL SOCIAL WORK SERVICES
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 3005 AVENUE H
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City | NEDERLAND
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State | TX
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Zip | 77627-7607
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Country | US
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Telephone | 409-724-1920
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Fax | 409-724-1102
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Provider Business Mailing Address
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Address Line | 3005 AVENUE H
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City | NEDERLAND
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State | TX
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Zip | 77627-7607
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Country | US
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Telephone | 409-724-1920
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Fax | 409-724-1102
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Authorized Official
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Title or Position | PARTNER
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Name | MS. CAROLYN JO BOURG
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Credential | LCSW
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Telephone | 409-724-1920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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