Provider Demographics
NPI:1952691263
Name:CRIDER, TEX MILTON II (LCSW)
Entity Type:Individual
Prefix:
First Name:TEX
Middle Name:MILTON
Last Name:CRIDER
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1152
Mailing Address - Country:US
Mailing Address - Phone:814-371-1100
Mailing Address - Fax:
Practice Address - Street 1:100 CALDWELL DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1152
Practice Address - Country:US
Practice Address - Phone:814-371-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0155451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical