Provider Demographics
NPI:1750688776
Name:WORTHLEY, THOMAS M (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:WORTHLEY
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 1:930 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7202
Mailing Address - Country:US
Mailing Address - Phone:817-641-8142
Mailing Address - Fax:817-641-4743
Practice Address - Street 1:930 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033
Practice Address - Country:US
Practice Address - Phone:254-495-8839
Practice Address - Fax:817-641-4743
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX515351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical