MEDICARE: KELLIE LOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	63958	TX

General Provider Information

NPI Number	:	1306479985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE LOMAS

Provider Business Mailing Address
First Line	:	700 N SAM HOUSTON PKWY W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-4335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12807 HAYNES RD BLDG C1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-1124
Country	:	US
Telephone Number	:	346-634-7571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	03/11/2026

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