Provider Demographics
NPI:1891831772
Name:TEXIDOR MALDONADO, CARLOS OBED (PHD, LPC, MAC, ACS)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:OBED
Last Name:TEXIDOR MALDONADO
Suffix:
Gender:M
Credentials:PHD, LPC, MAC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 NEOTA ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2185
Mailing Address - Country:US
Mailing Address - Phone:503-409-1906
Mailing Address - Fax:
Practice Address - Street 1:750 FRONT ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1089
Practice Address - Country:US
Practice Address - Phone:503-363-2021
Practice Address - Fax:503-363-4820
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORG 09-12-06101Y00000X
ORC7615101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator