Provider Demographics
NPI:1184043259
Name:PROCTOR, CARLA MACKEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:MACKEY
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CARLA
Other - Middle Name:JENE
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:202 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-1616
Mailing Address - Country:US
Mailing Address - Phone:214-886-9007
Mailing Address - Fax:972-784-7766
Practice Address - Street 1:202 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-1616
Practice Address - Country:US
Practice Address - Phone:214-886-9007
Practice Address - Fax:972-784-7766
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist