Provider Demographics
NPI:1952300162
Name:CLEARY, THOMAS J (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:CLEARY
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 1:4860 RHEA RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4404
Mailing Address - Country:US
Mailing Address - Phone:940-500-4408
Mailing Address - Fax:940-386-1318
Practice Address - Street 1:1708 DAYTON
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6110
Practice Address - Country:US
Practice Address - Phone:940-500-4408
Practice Address - Fax:940-386-1318
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS100231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108288504Medicaid
TX00S85QOtherBLUE CROSS BLUE SHIELD
TX108288502Medicaid
8F8337Medicare PIN