Provider Demographics
NPI:1083169650
Name:BASKINS MCCOY, ZAUNDRA K
Entity Type:Individual
Prefix:
First Name:ZAUNDRA
Middle Name:K
Last Name:BASKINS MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 BONITO DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4118
Mailing Address - Country:US
Mailing Address - Phone:682-215-5171
Mailing Address - Fax:
Practice Address - Street 1:6100 WESTERN PL STE 408
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4690
Practice Address - Country:US
Practice Address - Phone:817-735-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDIAGNOSTICIAN101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor