Healthcare Provider Details

I. General information

NPI: 1376224204
Provider Name (Legal Business Name): LAETARE GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 COMMERCIAL CENTER BLVD STE E200
KATY TX
77494-7823
US

IV. Provider business mailing address

PO BOX 6946
KATY TX
77491-6946
US

V. Phone/Fax

Practice location:
  • Phone: 832-900-2082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRIS STRAVITSCH
Title or Position: OWNER
Credential: LPC-S, LMFT-S
Phone: 832-900-2082