Carlos Ivan Acosta, MASTERS
Individual provider Active NPI Professional Counselor · Addison, TX
NPI 1124869268 · NPPES record last updated Jun 3, 2024
Key facts
- NPI
- 1124869268
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 94959 (TX)
- Practice address
- 15851 Dallas Pkwy
Addison, TX 75001-3369 - Phone
- (214) 267-9556
- Fax
- (833) 457-1700
- NPI assigned
- Jun 3, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94959 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cannenta Center for Healing and Empowerment LLC | Current |
Accepting new patients |
Locations
15851 Dallas Pkwy
Addison, TX 75001
Phone (214) 267-9556
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 94959 | TX | Yes |
Addresses
Primary practice location
15851 Dallas Pkwy
Addison, TX 75001-3369
Mailing address
3001 Lisa LN
Arlington, TX 76013-2039
Phone (817) 881-9804
Other providers in Addison, TX
- Asha Abraham
- Bridget Abraham
- Cody Academia
- Accountable Performance Health Solutions, LLC
- Accuzone Diagnostics, LLC
- Acute Hair Systems
- Tameka Lashuna Adams
- Todd Adams
- Addison Anesthesia Management LLC
- Addison Anesthesia PLLC
All providers in Addison, TX · Professional Counselor in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.