Provider Demographics
NPI:1780831396
Name:DEVEREAUX, AILEEN (LCSW)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:WAINWRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:605 SHADY LANE N
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248
Mailing Address - Country:US
Mailing Address - Phone:817-522-6622
Mailing Address - Fax:817-379-1933
Practice Address - Street 1:605 SHADY LANE N
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-522-6622
Practice Address - Fax:817-379-1933
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2879785-03Medicaid
TX2879785-02Medicaid
TX287978504Medicaid