MEDICARE: MS. CONSTANCE MARIE UPDIKE-CHILCOAT MS, LMFT

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	106H00000X	Marriage & Family Therapist	201012	TX

General Provider Information

NPI Number	:	1831458058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONSTANCE MARIE UPDIKE-CHILCOAT MS, LMFT

Provider Business Mailing Address
First Line	:	15314 BONITA SPRINGS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-1358
Country	:	US
Telephone Number	:	281-460-2320
Fax Number	:	281-575-6693

Provider Business Practice Location Address
First Line	:	15314 BONITA SPRINGS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-1358
Country	:	US
Telephone Number	:	281-460-2320
Fax Number	:	281-575-6693

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

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	05/08/2012

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