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General NPI Number Information
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NPI Number | 1871181669
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Entity Type | Individual
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Provider Name | SISILY RAINEY LPC
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Gender | Female
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 555 SPRING PARK CENTER BLVD APT 9308
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City | SPRING
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State | TX
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Zip | 77373-8253
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Country | US
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Telephone | 183-252-7697
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1966
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City | SPRING
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State | TX
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Zip | 77383-1966
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Country | US
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Telephone | 832-527-6977
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 79713
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License Number State | TX
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