Provider Demographics
NPI:1255469169
Name:ISAACS, GARY LEN (LCSW)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEN
Last Name:ISAACS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2328 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4638
Mailing Address - Country:US
Mailing Address - Phone:972-724-1959
Mailing Address - Fax:817-335-3617
Practice Address - Street 1:801 W CANNON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3147
Practice Address - Country:US
Practice Address - Phone:817-335-1994
Practice Address - Fax:817-335-3617
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83594WMedicare ID - Type Unspecified