Carlos Obed Texidor Maldonado, PHD, LPC, MAC, ACS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C7615 Issued in OR

Practice address

750 Front St NE
Salem, OR 97301-1089

Phone

(503) 363-2021

Fax

(503) 363-4820

NPI assigned

Jan 29, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/bridgewayrecovery/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bridgeway Recovery Services

  • Addiction (Substance Use Disorder) Counselor
  • Salem, OR
  • NPI 1083844401
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1891831772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 NEOTA ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012185",
            "telephone_number": "503-409-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 FRONT ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011089",
            "telephone_number": "503-363-2021",
            "fax_number": "503-363-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEXIDOR MALDONADO",
        "first_name": "CARLOS",
        "middle_name": "OBED",
        "name_prefix": "Mr.",
        "credential": "PHD, LPC, MAC, ACS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": "G 09-12-06",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C7615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Sean Terry
• Lauren Elizabeth Terry, M.D.
• Jamie Tessaro, LPN
• Blake Testa, D.C.
• Leigha Teubel, PTA
• Thanh Toan Tran Thai
• Joseph J Thaler, MD
• Natalie Nicole Thamert, LMT
• Cathy Diane Thayer
• The Good Place NW, Inc

• Mental Health Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.