MEDICARE: MR. FREDERICK CALVIN HARPER LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15748	TX

General Provider Information

NPI Number	:	1548955214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FREDERICK CALVIN HARPER LCDC

Provider Business Mailing Address
First Line	:	12903 BRANT ROCK DR APT 116
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5448
Country	:	US
Telephone Number	:	832-617-2377
Fax Number	:

Provider Business Practice Location Address
First Line	:	12903 BRANT ROCK DR APT 116
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5448
Country	:	US
Telephone Number	:	832-617-2377
Fax Number	:

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

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/13/2023

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