Provider Demographics
NPI:1720604309
Name:CALDWELL, DAN NORMAN JR (MA, LCDC-CCS, ADC)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:NORMAN
Last Name:CALDWELL
Suffix:JR
Gender:M
Credentials:MA, LCDC-CCS, ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25611 PANNIER PL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3699
Mailing Address - Country:US
Mailing Address - Phone:832-326-6276
Mailing Address - Fax:
Practice Address - Street 1:11999 KATY FWY STE 530
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1623
Practice Address - Country:US
Practice Address - Phone:832-443-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12278101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)