Healthcare Provider Details

I. General information

NPI: 1316633068
Provider Name (Legal Business Name): GIOVANNA HENRIQUEZ PENNICK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GIOVANNA SORAYA HENRIQUEZ

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 TIDEWATER DR
HOUSTON TX
77045-4342
US

IV. Provider business mailing address

4326 TIDEWATER DR
HOUSTON TX
77045-4342
US

V. Phone/Fax

Practice location:
  • Phone: 832-721-8352
  • Fax:
Mailing address:
  • Phone: 832-721-8352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number82048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: