Provider Demographics
NPI:1194841940
Name:DEVEREUX, JULIEN PORTER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JULIEN
Middle Name:PORTER
Last Name:DEVEREUX
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6162 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE #215
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2697
Mailing Address - Country:US
Mailing Address - Phone:469-644-3975
Mailing Address - Fax:214-827-9920
Practice Address - Street 1:6162 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE #215
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2697
Practice Address - Country:US
Practice Address - Phone:469-644-3975
Practice Address - Fax:214-827-9920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS179751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical