Provider Demographics
NPI:1508050725
Name:CAUDLE, DEBORAH GAIL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:GAIL
Last Name:CAUDLE
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 1:3009 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8724
Mailing Address - Country:US
Mailing Address - Phone:469-395-4491
Mailing Address - Fax:
Practice Address - Street 1:3009 EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8724
Practice Address - Country:US
Practice Address - Phone:469-395-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313721OtherBLUE CROSS BLUE SHIELD