Provider Demographics
NPI:1225500218
Name:RACKLEY, CALEB DANIEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:DANIEL
Last Name:RACKLEY
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 1:3105 MASTERS CIR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-6669
Mailing Address - Country:US
Mailing Address - Phone:903-565-0344
Mailing Address - Fax:
Practice Address - Street 1:3800 PALUXY DR STE 240
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1667
Practice Address - Country:US
Practice Address - Phone:903-283-8729
Practice Address - Fax:888-454-9083
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS353291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical