Provider Demographics
NPI:1083214415
Name:JEFFERSON, BARBARA (LCSW-S)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 BROWN DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4908
Mailing Address - Country:US
Mailing Address - Phone:512-963-8568
Mailing Address - Fax:
Practice Address - Street 1:1110 BROWN DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4908
Practice Address - Country:US
Practice Address - Phone:512-963-8568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0148461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical