Healthcare Provider Details

I. General information

NPI: 1275891517
Provider Name (Legal Business Name): CLAUDIA ESCALANTE GAMA LPC-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11999 KATY FWY STE 490
HOUSTON TX
77079-1608
US

IV. Provider business mailing address

11999 KATY FWY STE 490
HOUSTON TX
77079-1608
US

V. Phone/Fax

Practice location:
  • Phone: 281-509-0006
  • Fax: 281-597-9761
Mailing address:
  • Phone: 281-509-0006
  • Fax: 281-597-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number68972
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: