Provider Demographics
NPI:1730124892
Name:PENZES, PAISLEY W (LCSW)
Entity Type:Individual
Prefix:
First Name:PAISLEY
Middle Name:W
Last Name:PENZES
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 1:2701 VALLEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6571
Mailing Address - Country:US
Mailing Address - Phone:817-858-0230
Mailing Address - Fax:817-571-2663
Practice Address - Street 1:1109 N COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5545
Practice Address - Country:US
Practice Address - Phone:817-860-4080
Practice Address - Fax:817-860-4082
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00974HMedicare ID - Type Unspecified