Individual
GRACYN COSTILOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3500 OAK LAWN AVE STE 350, DALLAS, TX 75219-4327
(469) 665-9416
Mailing address
3500 OAK LAWN AVE STE 350, DALLAS, TX 75219-4327
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
105848
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105848
TEXAS STATE BOARD OF SOCIAL WORK EXMAINERS
TX
Enumeration date
08/25/2017
Last updated
11/04/2021
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