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General NPI Number Information
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NPI Number | 1225046634
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Entity Type | Organization
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Legal Business Name | CLEAR LAKE COUNSELING SERVICESPCINC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17629 EL CAMINO REAL 190
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City | HOUSTON
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State | TX
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Zip | 77058-2901
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Country | US
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Telephone | 281-280-0393
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Fax | 281-280-0123
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Provider Business Mailing Address
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Address Line | 17629 EL CAMINO REAL 190
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City | HOUSTON
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State | TX
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Zip | 77058-2901
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Country | US
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Telephone | 281-280-0393
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Fax | 281-280-0123
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS CYNTHIA LADDEL WHEELER
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Credential | L.C.D.C.
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Telephone | 281-289-0393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 752A
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License Number State | TX
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