Provider Demographics
NPI:1659024842
Name:CHACKO, BLESSY (LCSW)
Entity Type:Individual
Prefix:
First Name:BLESSY
Middle Name:
Last Name:CHACKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11606 ARBIRLOT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2257
Mailing Address - Country:US
Mailing Address - Phone:973-970-5457
Mailing Address - Fax:
Practice Address - Street 1:12340 JONES ROAD, STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2892
Practice Address - Country:US
Practice Address - Phone:832-756-2749
Practice Address - Fax:859-201-1151
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX593171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX394812701Medicaid