Healthcare Provider Details

I. General information

NPI: 1053446468
Provider Name (Legal Business Name): KATHRYN MARIAH NOMURA MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAH NOMURA

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5638 MEDICAL CENTER DR
KATY TX
77494-6325
US

IV. Provider business mailing address

12915 SHADY KNOLL LN
CYPRESS TX
77429-2211
US

V. Phone/Fax

Practice location:
  • Phone: 281-392-7505
  • Fax:
Mailing address:
  • Phone: 713-530-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: