Provider Demographics
NPI:1619638608
Name:NEISIUS, CAROLYN RODRIGUEZ (LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:RODRIGUEZ
Last Name:NEISIUS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5056
Mailing Address - Country:US
Mailing Address - Phone:682-328-3458
Mailing Address - Fax:
Practice Address - Street 1:8813 N TARRANT PKWY STE 205
Practice Address - Street 2:
Practice Address - City:N RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8461
Practice Address - Country:US
Practice Address - Phone:682-328-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68073101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor