Provider Demographics
NPI:1417199555
Name:CARTER, PATRICIA EILEEN (MA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EILEEN
Last Name:CARTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 BALCONES DR STE 201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4215
Mailing Address - Country:US
Mailing Address - Phone:512-298-9608
Mailing Address - Fax:
Practice Address - Street 1:1405 E 13TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-1127
Practice Address - Country:US
Practice Address - Phone:512-298-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00201948106H00000X
TX201839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist