Provider Demographics
NPI:1528090453
Name:LENNOX, CAROL (LPC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LENNOX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 CAMP BOWIE BLVD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5612
Mailing Address - Country:US
Mailing Address - Phone:817-933-2325
Mailing Address - Fax:817-377-0720
Practice Address - Street 1:6040 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5612
Practice Address - Country:US
Practice Address - Phone:817-933-2325
Practice Address - Fax:817-377-0720
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1562241-02Medicaid