MEDICARE: LECIA CAROL HURST

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	101YM0800X	Mental Health Counselor
2	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1962811646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LECIA CAROL HURST

Provider Business Mailing Address
First Line	:	8300 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5654
Country	:	US
Telephone Number	:	888-922-2843
Fax Number	:	855-568-2494

Provider Business Practice Location Address
First Line	:	8300 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5654
Country	:	US
Telephone Number	:	888-922-2843
Fax Number	:	855-568-2494

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

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	09/15/2022

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Directions to “ LECIA CAROL HURST ” Practice Location

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