Provider Demographics
NPI:1255896437
Name:CALDERAS, CARLA MIRTA (LPC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MIRTA
Last Name:CALDERAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12107 TURTLES CORNER LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1746
Mailing Address - Country:US
Mailing Address - Phone:346-303-8808
Mailing Address - Fax:
Practice Address - Street 1:8900 EASTLOCH DR STE 110F
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2338
Practice Address - Country:US
Practice Address - Phone:346-314-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health