Provider Demographics
NPI:1811565351
Name:NGUYEN, CARMELI
Entity Type:Individual
Prefix:
First Name:CARMELI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10931 TATTERSHALL LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6878
Mailing Address - Country:US
Mailing Address - Phone:817-903-2890
Mailing Address - Fax:
Practice Address - Street 1:10931 TATTERSHALL LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6878
Practice Address - Country:US
Practice Address - Phone:817-903-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2022-04-11
Deactivation Date:2021-06-24
Deactivation Code:
Reactivation Date:2021-07-09
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst