Provider Demographics
NPI:1770673097
Name:CROCKER, SALENA BELL (MSSW)
Entity Type:Individual
Prefix:MS
First Name:SALENA
Middle Name:BELL
Last Name:CROCKER
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:B
Other - Last Name:CROCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSSW
Mailing Address - Street 1:1310 S 1ST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3056
Mailing Address - Country:US
Mailing Address - Phone:512-306-1712
Mailing Address - Fax:512-447-4489
Practice Address - Street 1:1310 S 1ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3056
Practice Address - Country:US
Practice Address - Phone:512-306-1712
Practice Address - Fax:512-447-4489
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158758OtherVALUE OPTIONS
TX0004GZOtherBLUE CROSS & BLUE SHIELD