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General NPI Number Information
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NPI Number | 1578969655
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Entity Type | Organization
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Legal Business Name | CLEAR LAKE CHILDREN'S CENTER
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 17100 GLENMOUNT PARK DR STE C
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City | WEBSTER
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State | TX
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Zip | 77598-4368
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Country | US
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Telephone | 281-407-5658
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Fax | 281-407-5631
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Provider Business Mailing Address
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Address Line | 17100 GLENMOUNT PARK DR STE C
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City | WEBSTER
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State | TX
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Zip | 77598-4368
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Country | US
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Telephone | 281-407-5658
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Fax | 281-407-5631
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. BECKY SIEKIERSKI
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Credential | PHD, LSSP, NCSP
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Telephone | 281-407-5658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 33696
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License Number State | TX
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