MEDICARE: LETICIA LORET DE MOLA PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1099758	TX

General Provider Information

NPI Number	:	1689445710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETICIA LORET DE MOLA PMHNP-BC

Provider Business Mailing Address
First Line	:	1795 FRY RD # 281
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-3347
Country	:	US
Telephone Number	:	346-771-5220
Fax Number	:	346-771-5220

Provider Business Practice Location Address
First Line	:	23920 KATY FWY STE 440
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0881
Country	:	US
Telephone Number	:	346-771-5220
Fax Number	:	346-771-5220

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

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	01/27/2026

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