Provider Demographics
NPI:1942495940
Name:PICKARD, AVA LEIGH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AVA
Middle Name:LEIGH
Last Name:PICKARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 TURNER RD APT 713
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7253
Mailing Address - Country:US
Mailing Address - Phone:817-235-0883
Mailing Address - Fax:940-433-2144
Practice Address - Street 1:8821 DAVIS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0333
Practice Address - Country:US
Practice Address - Phone:817-235-0883
Practice Address - Fax:940-433-2144
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1197501-02Medicaid
TX1197501-02Medicaid