MEDICARE: NICOLA E WAISOME-CROOKS

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
1	101YP2500X	Professional Counselor	95891	TX

General Provider Information

NPI Number	:	1467280834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLA E WAISOME-CROOKS

Provider Business Mailing Address
First Line	:	3803 CLEMENTINE DR
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76549-5495
Country	:	US
Telephone Number	:	254-466-7972
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W CENTRAL TEXAS EXPY STE 208
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2080
Country	:	US
Telephone Number	:	254-432-5521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	07/29/2024

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