Provider Demographics
NPI:1588431001
Name:CAVIAR CLINICIAN, PLLC
Entity type:Organization
Organization Name:CAVIAR CLINICIAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KATELY
Authorized Official - Last Name:EAGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-A
Authorized Official - Phone:337-909-4552
Mailing Address - Street 1:539 WEST COMMERCE ST. #3754
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1953
Mailing Address - Country:US
Mailing Address - Phone:214-631-9762
Mailing Address - Fax:214-617-0282
Practice Address - Street 1:539 WEST COMMERCE ST. #3754
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-1953
Practice Address - Country:US
Practice Address - Phone:214-631-9762
Practice Address - Fax:214-617-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty