Healthcare Provider Details

I. General information

NPI: 1568878320
Provider Name (Legal Business Name): CARLYNNE FIKES LPC INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4314 YOAKUM BLVD
HOUSTON TX
77006-5864
US

IV. Provider business mailing address

4314 YOAKUM BLVD
HOUSTON TX
77006-5864
US

V. Phone/Fax

Practice location:
  • Phone: 713-850-0049
  • Fax: 713-627-7302
Mailing address:
  • Phone: 713-850-0049
  • Fax: 713-627-7302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number72499
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: