Healthcare Provider Details

I. General information

NPI: 1619275484
Provider Name (Legal Business Name): MARY MICHELE PEPPER LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8627 PLUM LAKE DR
HOUSTON TX
77095-3609
US

IV. Provider business mailing address

8627 PLUM LAKE DR
HOUSTON TX
77095-3609
US

V. Phone/Fax

Practice location:
  • Phone: 318-918-8905
  • Fax:
Mailing address:
  • Phone: 318-918-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3270
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3270
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3270
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3270
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number3270
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1045
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: