Provider Demographics
NPI:1376938365
Name:CLAMP NETWORK
Entity Type:Organization
Organization Name:CLAMP NETWORK
Other - Org Name:CAROL SEPULVEDA, CENTER FOR COUNSELING AND PLAY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST, SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAENZ-SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:281-433-8210
Mailing Address - Street 1:900 ROCKMEAD DR
Mailing Address - Street 2:SUITE 255
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2115
Mailing Address - Country:US
Mailing Address - Phone:281-433-8210
Mailing Address - Fax:281-898-7622
Practice Address - Street 1:900 ROCKMEAD DR
Practice Address - Street 2:SUITE 255
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2115
Practice Address - Country:US
Practice Address - Phone:281-433-8210
Practice Address - Fax:281-898-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04233305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization