Provider Demographics
NPI:1770362741
Name:GRAJALES, LUIZA GOMEZ (LCSW)
Entity type:Individual
Prefix:
First Name:LUIZA
Middle Name:GOMEZ
Last Name:GRAJALES
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 1:147 SAYLES BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-2001
Mailing Address - Country:US
Mailing Address - Phone:325-437-1852
Mailing Address - Fax:325-437-1855
Practice Address - Street 1:850 FM 574 W
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-3379
Practice Address - Country:US
Practice Address - Phone:325-938-5518
Practice Address - Fax:325-938-5665
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty