Healthcare Provider Details

I. General information

NPI: 1396430476
Provider Name (Legal Business Name): EDUARDO OLMEDO LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 ROOKIN ST STE 200
HOUSTON TX
77074-5019
US

IV. Provider business mailing address

5514 ALLENDALE RD
HOUSTON TX
77017-6312
US

V. Phone/Fax

Practice location:
  • Phone: 713-351-7350
  • Fax: 713-351-7351
Mailing address:
  • Phone: 713-291-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number85033
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: