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General NPI Number Information
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NPI Number | 1528249190
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Entity Type | Individual
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Provider Name | JORGE LUIS ANTELIZ LPC;LMHC; LCDC
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Gender | Male
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 10060 FUQUA STREET
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City | HOUSTON
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State | TX
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Zip | 77089
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Country | US
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Telephone | 713-948-7964
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 BLUE MIST DR
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City | SUGAR LAND
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State | TX
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Zip | 77498-4821
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Country | US
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Telephone | 713-732-7794
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 9296
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 476-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 69402
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License Number State | TX
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