=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194327239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NELLIANA ACUNA LASSES LMFT-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2020
-----------------------------------------------------
Last Update Date | 11/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11211 KATY FWY ST. 620
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-2126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-879-3086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14855 MEMORIAL DR APT 1612
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-5247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-879-3086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 203864
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------