Provider Demographics
NPI:1790794436
Name:HOUSTON, CAROL ANN (EDD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N MORNINGSIDE ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2430
Mailing Address - Country:US
Mailing Address - Phone:361-816-3628
Mailing Address - Fax:361-356-4364
Practice Address - Street 1:4838 HOLLY RD
Practice Address - Street 2:STE 201
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4770
Practice Address - Country:US
Practice Address - Phone:361-816-3628
Practice Address - Fax:361-356-4364
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2688103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1731861-01Medicaid
TX611714Medicare ID - Type Unspecified