MEDICARE: TAKIYA LANIECE CARADINE

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467036707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKIYA LANIECE CARADINE

Provider Business Mailing Address
First Line	:	8323 SOUTHWEST FWY STE 425
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1618
Country	:	US
Telephone Number	:	832-831-6178
Fax Number	:

Provider Business Practice Location Address
First Line	:	8323 SOUTHWEST FWY STE 425
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1618
Country	:	US
Telephone Number	:	832-831-6178
Fax Number	:	832-550-2814

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

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	05/12/2021

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Directions to “ TAKIYA LANIECE CARADINE ” Practice Location

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