Provider Demographics
NPI:1336886480
Name:WINDHAM, CARRIE (LMFTA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:TX
Mailing Address - Zip Code:79510-0551
Mailing Address - Country:US
Mailing Address - Phone:254-433-8869
Mailing Address - Fax:
Practice Address - Street 1:1500 INDUSTRIAL BLVD STE 305-B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7969
Practice Address - Country:US
Practice Address - Phone:254-433-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203619106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist