Provider Demographics
NPI:1679126460
Name:LOCASTE-WILKEN, BRENT ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ROBERT
Last Name:LOCASTE-WILKEN
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 1:12415 SHAWWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5544
Mailing Address - Country:US
Mailing Address - Phone:281-744-0152
Mailing Address - Fax:
Practice Address - Street 1:12415 SHAWWOOD CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5544
Practice Address - Country:US
Practice Address - Phone:281-744-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-20
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical