Provider Demographics
NPI:1033782974
Name:CARLETON COLLECTIVE
Entity Type:Organization
Organization Name:CARLETON COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BREEANN
Authorized Official - Middle Name:CASI
Authorized Official - Last Name:CARLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:210-774-0283
Mailing Address - Street 1:132 SPRINGTREE HOLW
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3227
Mailing Address - Country:US
Mailing Address - Phone:210-774-0283
Mailing Address - Fax:
Practice Address - Street 1:132 SPRINGTREE HOLW
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3227
Practice Address - Country:US
Practice Address - Phone:210-774-0283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty