Provider Demographics
NPI:1730887530
Name:BERRY, MCCAYLA (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:MCCAYLA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 NORCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-2319
Mailing Address - Country:US
Mailing Address - Phone:512-640-9448
Mailing Address - Fax:
Practice Address - Street 1:611 W 22ND ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1968
Practice Address - Country:US
Practice Address - Phone:713-380-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85724101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional