Healthcare Provider Details

I. General information

NPI: 1518086446
Provider Name (Legal Business Name): PENNY NESLONEY LEZAK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 WOODFOREST BLVD SUITE 110
HOUSTON TX
77015-3564
US

IV. Provider business mailing address

7703 BRIDLE PATH DR
HOUSTON TX
77044-2709
US

V. Phone/Fax

Practice location:
  • Phone: 713-453-2300
  • Fax: 713-453-2300
Mailing address:
  • Phone: 281-458-1967
  • Fax: 281-458-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: