Provider Demographics
NPI:1740302512
Name:EAGLE PAIN & STRESS CLINIC, INC
Entity type:Organization
Organization Name:EAGLE PAIN & STRESS CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPC
Authorized Official - Phone:832-794-1621
Mailing Address - Street 1:4542 NASSAU DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2115
Mailing Address - Country:US
Mailing Address - Phone:832-794-1621
Mailing Address - Fax:281-565-1853
Practice Address - Street 1:4542 NASSAU DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2115
Practice Address - Country:US
Practice Address - Phone:832-794-1621
Practice Address - Fax:281-565-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6082101YP2500X
TX1841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841OtherLMFT
1940OtherNTLBRDCERTCLINHYPNOTHERAP