1396885950 NPI number — CINDY ELAINE CARSWELL LPC

Table of content: CINDY ELAINE CARSWELL LPC (NPI 1396885950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396885950 NPI number — CINDY ELAINE CARSWELL LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARSWELL
Provider First Name:
CINDY
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396885950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
473 FM 3174
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOAQUIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75954-2436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-707-2803
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 FIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75935-3934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-590-9864
Provider Business Practice Location Address Fax Number:
936-590-9619
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  17171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1484289-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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