Provider Demographics
NPI:1659579027
Name:WOLCOTT, HERBERT A (LCSW, LMFT)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:A
Last Name:WOLCOTT
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 729081
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75372-9081
Mailing Address - Country:US
Mailing Address - Phone:214-373-1515
Mailing Address - Fax:214-373-1518
Practice Address - Street 1:8340 MEADOW RD
Practice Address - Street 2:SUITE 131
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3769
Practice Address - Country:US
Practice Address - Phone:214-373-1515
Practice Address - Fax:214-373-1518
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOP17247Medicare UPIN