Provider Demographics
NPI:1750674602
Name:PAX, CAROL ANN (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:PAX
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 1:5420 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6672
Mailing Address - Country:US
Mailing Address - Phone:956-631-9000
Mailing Address - Fax:956-631-9013
Practice Address - Street 1:5420 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6672
Practice Address - Country:US
Practice Address - Phone:956-631-9000
Practice Address - Fax:956-631-9013
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health