Healthcare Provider Details

I. General information

NPI: 1730003518
Provider Name (Legal Business Name): LAKE HOUSTON ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 ATASCOCITA RD STE 108
HUMBLE TX
77346-1995
US

IV. Provider business mailing address

2522 TWISTING PINE CT
KINGWOOD TX
77345-2350
US

V. Phone/Fax

Practice location:
  • Phone: 281-466-8494
  • Fax:
Mailing address:
  • Phone: 915-373-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY WYLIE
Title or Position: OWNER
Credential: DOM
Phone: 915-373-1107