Provider Demographics
NPI:1013765866
Name:GAULDIN, KAMDEN
Entity Type:Individual
Prefix:
First Name:KAMDEN
Middle Name:
Last Name:GAULDIN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 N. LOOP 288
Mailing Address - Street 2:APT #I11
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10100 N CENTRAL EXPY STE 240
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4113
Practice Address - Country:US
Practice Address - Phone:214-448-8557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician