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1800 Judson Rd Ste. 100 Longview TX 75605-4708 | |
| (903) 212-3153 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1800 Judson Rd, Longview, Texas |
| Authorized Official Name and Position | Earlene Cook (OFFICE MANAGER) |
| Authorized Official Contact | 9033536371 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1800 Judson Rd Ste. 100 Longview TX 75605-4708 Ph: (903) 212-3153 | 1800 Judson Rd Ste. 100 Longview TX 75605-4708 Ph: (903) 212-3153 |
| NPI Number | 1467994392 |
|---|---|
| Provider Enumeration Date | 11/09/2016 |
| Last Update Date | 11/09/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467994392 | NPI | - | NPPES |
| 1487920419 | Other | TX | NPI |
| 1457442816 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | S08843 (Texas) | Primary |
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