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General NPI Number Information
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NPI Number | 1962504498
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Entity Type | Individual
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Provider Name | GRACE MCCAULEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/04/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5221 N PARK RD
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City | TEXARKANA
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State | TX
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Zip | 75503-2664
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Country | US
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Telephone | 903-791-1051
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Fax |
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Provider Business Mailing Address
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Address Line | 8155 COYOTE TRL
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City | TEXARKANA
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State | TX
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Zip | 75503-9655
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Country | US
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Telephone | 903-791-1051
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 38579
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License Number State | TX
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