MEDICARE: LAQUITA SMALL MA, LPC

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	71572	TX

General Provider Information

NPI Number	:	1568015832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAQUITA SMALL MA, LPC

Provider Business Mailing Address
First Line	:	1819 FLYCASTER DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-7521
Country	:	US
Telephone Number	:	281-509-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	1819 FLYCASTER DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-7521
Country	:	US
Telephone Number	:	281-509-1843
Fax Number	:

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/09/2025

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