Active NPI
Colleen Gail Percival, LCSW
- Clinical Social Worker
- Keller, TX
National Provider Identifier
1447367131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 38494
- Practice address
- 620 Stoneglen Dr Ste I
Keller, TX 76248-1315 - Phone
- (682) 593-1318
- NPI assigned
- Aug 25, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 341020-3501 | UT | |
| Clinical Social Worker | 1041C0700X | 38494 | TX | Primary |
Addresses
Primary practice location
620 Stoneglen Dr Ste I
Keller, TX 76248-1315
Mailing address
620 Stoneglen Dr Ste I
Keller, TX 76248-1315
Phone (682) 593-1318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38494 | TX | MD | Psychologist |
| 341020-3501 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631923200000",
"number": "1447367131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 STONEGLEN DR STE I",
"city": "KELLER",
"state": "TX",
"postal_code": "762481315",
"telephone_number": "682-593-1318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 STONEGLEN DR STE I",
"city": "KELLER",
"state": "TX",
"postal_code": "762481315",
"telephone_number": "682-593-1318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERCIVAL",
"first_name": "COLLEEN",
"middle_name": "GAIL",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-25",
"last_updated": "2021-09-18",
"certification_date": "2021-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "341020-3501",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "38494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Keller, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.