Basic Information
| Provider Information | |||||||||
| NPI: | 1619556990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENASCO | ||||||||
| FirstName: | HEATHER | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9311 PRIMROSE AVE | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794247700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8069394883 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6104 AVENUE Q | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794123506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064723400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2021 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 34791 | TX | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.