Provider Demographics
NPI:1093835498
Name:COSTELLO, CAROL ROYER (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ROYER
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 MARBLE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3092
Mailing Address - Country:US
Mailing Address - Phone:817-473-6261
Mailing Address - Fax:817-795-9668
Practice Address - Street 1:800 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-5899
Practice Address - Country:US
Practice Address - Phone:817-548-0300
Practice Address - Fax:817-795-9668
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health