Provider Demographics
NPI:1255090320
Name:SCHENCK, THOMAS RICHARD (LPC, MA, MS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:SCHENCK
Suffix:
Gender:M
Credentials:LPC, MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 COUNTY ROAD 1604
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-4512
Mailing Address - Country:US
Mailing Address - Phone:817-360-1067
Mailing Address - Fax:
Practice Address - Street 1:150 COUNTY ROAD 1604
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-4512
Practice Address - Country:US
Practice Address - Phone:817-360-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional