Provider Demographics
NPI:1194203695
Name:BIRKS, JAN L (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:L
Last Name:BIRKS
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 LANGSTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-3622
Mailing Address - Country:US
Mailing Address - Phone:817-770-6937
Mailing Address - Fax:
Practice Address - Street 1:2025 LANGSTON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-3622
Practice Address - Country:US
Practice Address - Phone:817-770-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12651101YA0400X
TX667811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)