Provider Demographics
NPI:1972930683
Name:PATRICK, TANEKA L (LCSW-S)
Entity Type:Individual
Prefix:MS
First Name:TANEKA
Middle Name:L
Last Name:PATRICK
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:MS
Other - First Name:TANEKA
Other - Middle Name:L
Other - Last Name:READER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 10284
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-0284
Mailing Address - Country:US
Mailing Address - Phone:575-693-3818
Mailing Address - Fax:
Practice Address - Street 1:2820 W AVENUE O STE B
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-213-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-084711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical