MEDICARE: DESIRAE L. POCKLINGTON MA,LPC, TIYT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	77979	TX

General Provider Information

NPI Number	:	1033772330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIRAE L. POCKLINGTON MA,LPC, TIYT

Provider Business Mailing Address
First Line	:	12238 QUEENSTON BLVD STE G
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5351
Country	:	US
Telephone Number	:	713-540-4345
Fax Number	:

Provider Business Practice Location Address
First Line	:	12238 QUEENSTON BLVD STE G
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5351
Country	:	US
Telephone Number	:	713-540-4345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2019
Last Update Date	:	04/22/2019

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