Provider Demographics
NPI:1295929487
Name:BECKER, CAROLYN BLACK (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:BLACK
Last Name:BECKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 NW MILITARY HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1871
Mailing Address - Country:US
Mailing Address - Phone:210-302-6920
Mailing Address - Fax:
Practice Address - Street 1:12500 NW MILITARY HWY STE 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1871
Practice Address - Country:US
Practice Address - Phone:210-302-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical