Healthcare Provider Details

I. General information

NPI: 1962811646
Provider Name (Legal Business Name): LECIA CAROL HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 FM 1960 RD W
HOUSTON TX
77070-5654
US

IV. Provider business mailing address

8300 FM 1960 RD W
HOUSTON TX
77070-5654
US

V. Phone/Fax

Practice location:
  • Phone: 888-922-2843
  • Fax: 855-568-2494
Mailing address:
  • Phone: 888-922-2843
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: