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NPI Code Detail

MEDICARE: DR. DIANA R. CARLETON ED.D.

MEDICARE: DR. DIANA R. CARLETON ED.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist2-3672TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12-3672OTHERTXPSYCHOLOGIST

General Provider Information

NPI Number : 1083727549
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANA R. CARLETON ED.D.
Provider Business Mailing Address
First Line : 3100 75TH ST APT 4
Second Line :
City : GALVESTON
State : TX
Zip : 77551-1646
Country : US
Telephone Number : 713-628-6761
Fax Number : 409-744-0386
Provider Business Practice Location Address
First Line : 3316 MOUNT VERNON ST
Second Line :
City : HOUSTON
State : TX
Zip : 77006-3829
Country : US
Telephone Number : 713-628-6761
Fax Number : 409-744-0386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2006
Last Update Date : 07/08/2007

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