Provider Demographics
NPI:1477911998
Name:CRAIN, VIVIAN (LMSW)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:CRAIN
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 1:509 ABRAHAM CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-6961
Mailing Address - Country:US
Mailing Address - Phone:469-735-2937
Mailing Address - Fax:
Practice Address - Street 1:509 ABRAHAM CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-6961
Practice Address - Country:US
Practice Address - Phone:469-735-2937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61049171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator