Provider Demographics
NPI:1568470987
Name:MCCRARY, TERESA ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ROSE
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-0203
Mailing Address - Country:US
Mailing Address - Phone:512-930-3752
Mailing Address - Fax:512-864-0930
Practice Address - Street 1:1504 LEANDER RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8801
Practice Address - Country:US
Practice Address - Phone:512-864-9262
Practice Address - Fax:512-864-0930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0028LJOtherBLUE CROSS BLUE SHIELD
TX0028LJOtherBLUE CROSS BLUE SHIELD