Provider Demographics
NPI:1376851816
Name:DOROUGH, CHELSEA RENEE (LCSW (MSW))
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:RENEE
Last Name:DOROUGH
Suffix:
Gender:F
Credentials:LCSW (MSW)
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:RENEE
Other - Last Name:SWANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 MERCANTILE PLAZA DR, STE. 307
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137
Mailing Address - Country:US
Mailing Address - Phone:817-232-9400
Mailing Address - Fax:817-232-9403
Practice Address - Street 1:4500 MERCANTILE PLAZA DR, STE. 307
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137
Practice Address - Country:US
Practice Address - Phone:817-232-9400
Practice Address - Fax:817-232-9403
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TX680881041C0700X
CAASW347161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
13622419OtherCAQH