Healthcare Provider Details

I. General information

NPI: 1043136567
Provider Name (Legal Business Name): CALESHEA RENE' WHARTON SSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 BIG HORN DR
HOUSTON TX
77090-1862
US

IV. Provider business mailing address

1619 BIG HORN DR
HOUSTON TX
77090-1862
US

V. Phone/Fax

Practice location:
  • Phone: 281-748-7963
  • Fax:
Mailing address:
  • Phone: 281-748-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number72948
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: