Provider Demographics
NPI:1265596118
Name:CALDWELL, THRESA ANNETTE (MA, LBSW)
Entity type:Individual
Prefix:MRS
First Name:THRESA
Middle Name:ANNETTE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MA, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 COUNTY ROAD 256
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-0415
Mailing Address - Country:US
Mailing Address - Phone:936-560-4365
Mailing Address - Fax:936-560-4365
Practice Address - Street 1:1705 COUNTY ROAD 256
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-0415
Practice Address - Country:US
Practice Address - Phone:936-560-4365
Practice Address - Fax:936-560-4365
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27886171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1808792-01Medicaid