Provider Demographics
NPI:1902279490
Name:CHRISMAN-FEWELL, INDIRA (LCSW)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:CHRISMAN-FEWELL
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:PO BOX 2211
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0040
Mailing Address - Country:US
Mailing Address - Phone:833-282-7378
Mailing Address - Fax:833-329-4968
Practice Address - Street 1:9555 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6095
Practice Address - Country:US
Practice Address - Phone:833-282-7378
Practice Address - Fax:833-329-4968
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK66391041C0700X
TX659881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical