Provider Demographics
NPI:1427145853
Name:SPECKMAN, CAROL (LPC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SPECKMAN
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:PO BOX 940165
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-0165
Mailing Address - Country:US
Mailing Address - Phone:972-424-9212
Mailing Address - Fax:972-509-1450
Practice Address - Street 1:100 N CENTRAL EXPY
Practice Address - Street 2:SUITE 402
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5332
Practice Address - Country:US
Practice Address - Phone:972-786-6464
Practice Address - Fax:214-238-1221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6650LCOtherBCBS PROVIDER NUMBER