Provider Demographics
NPI:1609303791
Name:AILEEN WAINWRIGHT, LCSW INC.
Entity Type:Organization
Organization Name:AILEEN WAINWRIGHT, LCSW INC.
Other - Org Name:KELLER HEIGHTS COUNSELING & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVEREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:817-522-6622
Mailing Address - Street 1:605 SHADY LN N
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2645
Mailing Address - Country:US
Mailing Address - Phone:817-522-6622
Mailing Address - Fax:817-379-1933
Practice Address - Street 1:605 SHADY LN N
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2645
Practice Address - Country:US
Practice Address - Phone:817-522-6622
Practice Address - Fax:817-379-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-19
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412871041C0700X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2879785-03Medicaid
TX2879785-02Medicaid
TX400299001Medicaid
TX2879785-04Medicaid