Provider Demographics
NPI:1295942613
Name:CHILDRENS ADVOCACY CENTER OF GRAYSON COUNTY
Entity type:Organization
Organization Name:CHILDRENS ADVOCACY CENTER OF GRAYSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUCKOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-957-0440
Mailing Address - Street 1:910 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2831
Mailing Address - Country:US
Mailing Address - Phone:903-957-0440
Mailing Address - Fax:
Practice Address - Street 1:910 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2831
Practice Address - Country:US
Practice Address - Phone:903-957-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18459101YP2500X
TX17819101YP2500X
TX19101101YP2500X
TX20329101YP2500X
TX16137101YP2500X
TX19737101YP2500X
TX18627101YP2500X
TX33929104100000X
TX07159104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty