Provider Demographics
NPI:1881582542
Name:MOULDER, KALA
Entity type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:MOULDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14056 WOOL PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78252-4623
Mailing Address - Country:US
Mailing Address - Phone:210-970-9419
Mailing Address - Fax:
Practice Address - Street 1:9258 CULEBRA RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2872
Practice Address - Country:US
Practice Address - Phone:210-727-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health