Crockett, Jeanne V
Crockett, Jeanne V is an individual health care provider with primary practice located at 3840 Hulen St Htn, Client Accounting, Fort Worth TX 76107-7277. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Crockett, Jeanne V can be contacted via phone (817) 569-4395.Contact Information
Primary practice address
3840 Hulen St Htn, Client Accounting
Fort Worth TX 76107-7277
Phone: (817) 569-4395
Fax: (817) 569-4517
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | S27688 | Texas |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | S27688 | Texas |
Profile Details
| NPI number | 1306909890 |
|---|---|
| LBN Legal business name | Crockett, Jeanne V |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 18th, 2006 |
| Last updated | Jan 19th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306909890 | NPPES |
| Texas | MEDICAID | 071171502 | |
| Texas | MEDICAID | 071171504 | |
| Texas | MEDICAID | 071171503 | |
| Texas | Other | 87607Q |
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