Provider Demographics
NPI:1104836949
Name:REEP, ELIZABETH WINIFRED (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:WINIFRED
Last Name:REEP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:WINIFRED
Other - Last Name:CURL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1796 HIDDEN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-8334
Mailing Address - Country:US
Mailing Address - Phone:817-715-2785
Mailing Address - Fax:
Practice Address - Street 1:760 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4635
Practice Address - Country:US
Practice Address - Phone:817-715-2785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX361131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611941Medicare ID - Type Unspecified