=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184904385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES DINH LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2011
-----------------------------------------------------
Last Update Date | 02/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10850 TEXAN RIDER DR
-----------------------------------------------------
City | CROWLEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76036-9414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-703-7048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 CHAPARRAL LN
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76048-2509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-638-2010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 61941
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------