Provider Demographics
NPI:1588854186
Name:TEPPER, JEFFREY W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:W
Last Name:TEPPER
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 1:5402 ARAPAHO RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-6905
Mailing Address - Country:US
Mailing Address - Phone:972-437-9950
Mailing Address - Fax:972-437-1988
Practice Address - Street 1:5402 ARAPAHO RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-6905
Practice Address - Country:US
Practice Address - Phone:972-437-9950
Practice Address - Fax:972-437-1988
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214393104100000X
TX542021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA214393OtherLCSW
TX54202OtherTEXAS BOARD OF SOCIAL WORK EXAMINERS