MEDICARE: RATTIKA OU LCSW

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	1041C0700X	Clinical Social Worker	LCSW-4931	HI
2	1041C0700X	Clinical Social Worker	107387	TX

General Provider Information

NPI Number	:	1700659596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RATTIKA OU LCSW

Provider Business Mailing Address
First Line	:	13810 CHAMPION FOREST DR STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1883
Country	:	US
Telephone Number	:	346-299-7980
Fax Number	:

Provider Business Practice Location Address
First Line	:	13810 CHAMPION FOREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1844
Country	:	US
Telephone Number	:	808-228-0491
Fax Number	:

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

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	12/29/2024

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