Provider Demographics
NPI:1962504498
Name:MCCAULEY, GRACE (LCSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MCCAULEY
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 1:8155 COYOTE TRL
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-9655
Mailing Address - Country:US
Mailing Address - Phone:903-791-1051
Mailing Address - Fax:
Practice Address - Street 1:5221 N PARK RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2664
Practice Address - Country:US
Practice Address - Phone:903-791-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00 18 JZOtherBLUE CROSS BLUE SHIELD
TX00 810 PMedicare ID - Type UnspecifiedLCSW