Provider Demographics
NPI:1669002937
Name:EGERTON, VANESSSA IRENE (LCSW)
Entity Type:Individual
Prefix:
First Name:VANESSSA
Middle Name:IRENE
Last Name:EGERTON
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 1:17618 BENT CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-5708
Mailing Address - Country:US
Mailing Address - Phone:713-397-5047
Mailing Address - Fax:
Practice Address - Street 1:17618 BENT CYPRESS DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-5708
Practice Address - Country:US
Practice Address - Phone:713-397-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041S0200X
TX575461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool