Provider Demographics
NPI:1982135059
Name:CROTHERS, IMELDA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:JEAN
Last Name:CROTHERS
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 1:52 RICHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-5769
Mailing Address - Country:US
Mailing Address - Phone:254-654-0055
Mailing Address - Fax:
Practice Address - Street 1:52 RICHLAND DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-5769
Practice Address - Country:US
Practice Address - Phone:254-654-0055
Practice Address - Fax:800-747-3074
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX552891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX55289OtherTX LCSW LICENSE