MEDICARE: DESOBE COUNSELING & CONSULTATION PLLC

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	103TC0700X	Clinical Psychologist	23403	TX

General Provider Information

NPI Number	:	1467836262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESOBE COUNSELING & CONSULTATION PLLC

Provider Business Mailing Address
First Line	:	4306 YOAKUM BLVD
Second Line	:	SUITE 565
City	:	HOUSTON
State	:	TX
Zip	:	77006-5851
Country	:	US
Telephone Number	:	713-459-7332
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 YOAKUM BLVD
Second Line	:	SUITE 565
City	:	HOUSTON
State	:	TX
Zip	:	77006-5851
Country	:	US
Telephone Number	:	713-459-7332
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SANDRA L DESOBE
Credential	:	MA, LPC, LMFT
Telephone Number	:	713-459-7332

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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