Provider Demographics
NPI:1689680506
Name:CALDERON, CARLOS RENE (LPC, S)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:RENE
Last Name:CALDERON
Suffix:
Gender:M
Credentials:LPC, S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25227 GROGANS MILL RD # 205
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2951
Mailing Address - Country:US
Mailing Address - Phone:281-419-2323
Mailing Address - Fax:281-419-0744
Practice Address - Street 1:25227 GROGANS MILL RD # 205
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2951
Practice Address - Country:US
Practice Address - Phone:281-419-2323
Practice Address - Fax:281-419-0744
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17675101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192509Medicaid