Healthcare Provider Details

I. General information

NPI: 1407111453
Provider Name (Legal Business Name): FATIMAH I. ESCOBAR LPC-I, CI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18219 FLINT HILL DR
KATY TX
77449-8494
US

IV. Provider business mailing address

18219 FLINT HILL DR
KATY TX
77449-8494
US

V. Phone/Fax

Practice location:
  • Phone: 832-752-1910
  • Fax:
Mailing address:
  • Phone: 832-752-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67476
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: