Provider Demographics
NPI:1992951701
Name:CALDWELL, DAVID MARTIN (MA, LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARTIN
Last Name:CALDWELL
Suffix:
Gender:M
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 1:2611 LEE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4247
Mailing Address - Country:US
Mailing Address - Phone:903-454-6334
Mailing Address - Fax:903-454-1153
Practice Address - Street 1:2611 LEE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4247
Practice Address - Country:US
Practice Address - Phone:903-454-6334
Practice Address - Fax:903-454-1153
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional