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NPI Code Detail

MEDICARE: CARLA JO CAVAZOS

MEDICARE: CARLA JO CAVAZOS
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
1101YP2500XProfessional Counselor96970TX

General Provider Information

NPI Number : 1124835228
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA JO CAVAZOS
Provider Business Mailing Address
First Line : 8150 N CENTRAL EXPY STE 1625
Second Line :
City : DALLAS
State : TX
Zip : 75206-1806
Country : US
Telephone Number : 214-530-0021
Fax Number : 214-530-0021
Provider Business Practice Location Address
First Line : 550 WESTCOTT ST STE 220
Second Line :
City : HOUSTON
State : TX
Zip : 77007-6086
Country : US
Telephone Number : 214-530-0021
Fax Number : 214-530-0021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2024
Last Update Date : 06/01/2026

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