Provider Demographics
NPI:1992286124
Name:CASE, WENDY (LCDC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CASE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5269 FM 580 E
Mailing Address - Street 2:
Mailing Address - City:KEMPNER
Mailing Address - State:TX
Mailing Address - Zip Code:76539-8754
Mailing Address - Country:US
Mailing Address - Phone:254-833-4568
Mailing Address - Fax:
Practice Address - Street 1:1216 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-7409
Practice Address - Country:US
Practice Address - Phone:254-577-4880
Practice Address - Fax:254-518-5300
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79796101YM0800X
TX14512101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health