Provider Demographics
NPI:1497552145
Name:BERDIEL, OTTO (LPC-S, LCDC)
Entity type:Individual
Prefix:
First Name:OTTO
Middle Name:
Last Name:BERDIEL
Suffix:
Gender:M
Credentials:LPC-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S MILLBEND DR APT 1208
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1853
Mailing Address - Country:US
Mailing Address - Phone:915-251-3466
Mailing Address - Fax:
Practice Address - Street 1:2500 S MILLBEND DR APT 1208
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-1853
Practice Address - Country:US
Practice Address - Phone:915-251-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14127101YA0400X
TX82312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)