MEDICARE: CRAIG STUART BLACK LPC-S, LCDC

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	101YP2500X	Professional Counselor	72223	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	12460	TX

General Provider Information

NPI Number	:	1073991550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG STUART BLACK LPC-S, LCDC

Provider Business Mailing Address
First Line	:	17350 STATE HIGHWAY 249 STE 220
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1132
Country	:	US
Telephone Number	:	214-699-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	17350 STATE HIGHWAY 249 STE 220
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1132
Country	:	US
Telephone Number	:	214-699-9016
Fax Number	:

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	04/08/2026

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