Provider Demographics
NPI:1356629034
Name:WAUGHTAL, PATRICIA LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:WAUGHTAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 NORTH LOOP W
Mailing Address - Street 2:SUITE 370
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8127
Mailing Address - Country:US
Mailing Address - Phone:713-447-1709
Mailing Address - Fax:
Practice Address - Street 1:2040 NORTH LOOP W
Practice Address - Street 2:SUITE 370
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8127
Practice Address - Country:US
Practice Address - Phone:713-447-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22232104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker