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General NPI Number Information
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NPI Number | 1467917971
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Entity Type | Individual
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Provider Name | EDIANY DESOUSA
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Gender | Female
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 21230 KINGSLAND BLVD STE 300
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City | KATY
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State | TX
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Zip | 77450-6130
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Country | US
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Telephone | 281-984-3494
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Fax |
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Provider Business Mailing Address
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Address Line | 18670 FORTY SIX PKWY UNIT I
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City | SPRING BRANCH
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State | TX
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Zip | 78070-6911
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Country | US
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Telephone | 308-481-1644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 92352
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License Number State | TX
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