Provider Demographics
NPI:1144767062
Name:PROSERV SOCIAL WORK
Entity Type:Organization
Organization Name:PROSERV SOCIAL WORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR & CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-863-8800
Mailing Address - Street 1:801 WASHINGTON AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1266
Mailing Address - Country:US
Mailing Address - Phone:254-863-8801
Mailing Address - Fax:855-333-3759
Practice Address - Street 1:801 WASHINGTON AVE STE 602
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1266
Practice Address - Country:US
Practice Address - Phone:254-863-8801
Practice Address - Fax:855-333-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57225104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty