Healthcare Provider Details

I. General information

NPI: 1639272875
Provider Name (Legal Business Name): ANGELA HARRIS CAUGHLIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 MAIN ST
HOUSTON TX
77030-2348
US

IV. Provider business mailing address

2 E GREENWAY PLZ SUITE 900
HOUSTON TX
77046-0297
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-2500
  • Fax:
Mailing address:
  • Phone: 713-798-1750
  • Fax: 713-798-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16871
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: