Provider Demographics
NPI:1245800697
Name:CLAVO, NADINE LUCERTIA (LPC)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:LUCERTIA
Last Name:CLAVO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 WILD DEER WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4332
Mailing Address - Country:US
Mailing Address - Phone:504-473-1641
Mailing Address - Fax:
Practice Address - Street 1:1720 WILD DEER WAY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4332
Practice Address - Country:US
Practice Address - Phone:504-473-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional