Provider Demographics
NPI:1821240284
Name:WILLINGHAM, CAROL MEYER (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MEYER
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-5690
Mailing Address - Country:US
Mailing Address - Phone:254-458-5018
Mailing Address - Fax:
Practice Address - Street 1:2 N MAIN ST AT THOMAS ARNOLD ROAD
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-0767
Practice Address - Country:US
Practice Address - Phone:254-458-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist