=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811536980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARDI CALDWELL MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2020
-----------------------------------------------------
Last Update Date | 02/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 WESTWAY PL
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76018-5245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-741-7105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 ADAMS LN
-----------------------------------------------------
City | KAUFMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75142-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-741-7105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 83063
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------