Provider Demographics
NPI:1417462250
Name:CARO, TINA LEE (EDD, LPC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:LEE
Last Name:CARO
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14260 LARIAT TRL
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:TX
Mailing Address - Zip Code:79758-4347
Mailing Address - Country:US
Mailing Address - Phone:432-559-3060
Mailing Address - Fax:
Practice Address - Street 1:14260 LARIAT TRL
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:TX
Practice Address - Zip Code:79758-4347
Practice Address - Country:US
Practice Address - Phone:432-559-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82-3493005Medicaid