Provider Demographics
NPI:1720534399
Name:JANE E. WALVOORD, LCSW
Entity type:Organization
Organization Name:JANE E. WALVOORD, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-271-2602
Mailing Address - Street 1:5295 N TRAVIS ST
Mailing Address - Street 2:NO. 6102
Mailing Address - City:KNOLLWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 W LAMBERTH RD
Practice Address - Street 2:SUITE A
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2661
Practice Address - Country:US
Practice Address - Phone:214-468-4339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX568041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty