Provider Demographics
NPI:1114142288
Name:SAVANT, MOLLY ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ANN
Last Name:SAVANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WILDCAT DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2817
Mailing Address - Country:US
Mailing Address - Phone:361-445-4080
Mailing Address - Fax:888-413-3010
Practice Address - Street 1:1700 WILDCAT DR
Practice Address - Street 2:SUITE D
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2817
Practice Address - Country:US
Practice Address - Phone:361-445-4080
Practice Address - Fax:888-413-3010
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528259-02Medicaid