Provider Demographics
NPI:1467280834
Name:WAISOME-CROOKS, NICOLA E
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:E
Last Name:WAISOME-CROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 CLEMENTINE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5495
Mailing Address - Country:US
Mailing Address - Phone:254-466-7972
Mailing Address - Fax:
Practice Address - Street 1:100 W CENTRAL TEXAS EXPY STE 208
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2080
Practice Address - Country:US
Practice Address - Phone:254-432-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional