Healthcare Provider Details

I. General information

NPI: 1689304479
Provider Name (Legal Business Name): HARIS CICEKLIC LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 COUNTRY PLACE DR APT 122
HOUSTON TX
77079-5514
US

IV. Provider business mailing address

801 COUNTRY PLACE DR APT 122
HOUSTON TX
77079-5514
US

V. Phone/Fax

Practice location:
  • Phone: 832-312-5573
  • Fax:
Mailing address:
  • Phone: 832-312-5573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number82792
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: