Provider Demographics
NPI:1306374897
Name:HA, CAROLYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:HA
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 1:902 REINERMAN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5239
Mailing Address - Country:US
Mailing Address - Phone:281-615-0200
Mailing Address - Fax:
Practice Address - Street 1:3730 KIRBY DR STE 800
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3982
Practice Address - Country:US
Practice Address - Phone:281-615-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37694103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent