Provider Demographics
NPI:1386854065
Name:SOCIAL WORK CONNECTION
Entity Type:Organization
Organization Name:SOCIAL WORK CONNECTION
Other - Org Name:GAYLA KAY GRISHAM, LBSW-IPR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOCIAL WORKER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GRISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW-IPR
Authorized Official - Phone:254-405-2702
Mailing Address - Street 1:680 APPLE CROSS COURT
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706
Mailing Address - Country:US
Mailing Address - Phone:254-405-2702
Mailing Address - Fax:866-405-5256
Practice Address - Street 1:680 APPLE CROSS COURT
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:TX
Practice Address - Zip Code:76706
Practice Address - Country:US
Practice Address - Phone:254-405-2702
Practice Address - Fax:866-405-5256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCIAL WORK CONNECTION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33966251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182406401Medicaid
TX33966OtherLICENSED BOARD SOCIAL WOR
TX182405401Medicaid
TX182404701Medicaid