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NPI Code Detail

MEDICARE: JANICE HALSTEAD LCSW

MEDICARE: JANICE HALSTEAD LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6012TN
21041C0700XClinical Social Worker62121TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265542831
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE HALSTEAD LCSW
Provider Business Mailing Address
First Line : 10710 OLD HIGHWAY 64
Second Line :
City : BOLIVAR
State : TN
Zip : 38008-3587
Country : US
Telephone Number : 731-658-6113
Fax Number : 731-658-1597
Provider Business Practice Location Address
First Line : 4635 SOUTHWEST FWY STE 635
Second Line :
City : HOUSTON
State : TX
Zip : 77027-7112
Country : US
Telephone Number : 713-850-0049
Fax Number : 731-967-8784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 10/02/2023

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