Provider Demographics
NPI:1083945869
Name:CARDWELL, ERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:CARDWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4407
Mailing Address - Country:US
Mailing Address - Phone:830-739-8185
Mailing Address - Fax:830-896-3772
Practice Address - Street 1:320 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4407
Practice Address - Country:US
Practice Address - Phone:830-739-8185
Practice Address - Fax:830-896-3772
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11724101YP2500X
TX38315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095366301Medicaid