Provider Demographics
NPI:1134671142
Name:SCRUGGS, WANDA TIMMONS (LPC, LPC-S)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:TIMMONS
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:LPC, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 FM 3343
Mailing Address - Street 2:
Mailing Address - City:JOAQUIN
Mailing Address - State:TX
Mailing Address - Zip Code:75954-3378
Mailing Address - Country:US
Mailing Address - Phone:318-655-1999
Mailing Address - Fax:936-270-8720
Practice Address - Street 1:100 CONNELL FERRY ROAD
Practice Address - Street 2:
Practice Address - City:JOAQUIN
Practice Address - State:TX
Practice Address - Zip Code:75954-3378
Practice Address - Country:US
Practice Address - Phone:318-655-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65687101YP2500X
LA6289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional