Provider Demographics
NPI:1346361367
Name:KARAGULIAN, TINA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:S
Last Name:KARAGULIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 OLNEY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4941
Mailing Address - Country:US
Mailing Address - Phone:210-402-7101
Mailing Address - Fax:
Practice Address - Street 1:215 MELLIFF DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7130
Practice Address - Country:US
Practice Address - Phone:210-402-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0073NNOtherBCBS PROVIDER NUMBER
TX60054OtherAETNA PROVIDER NUMBER