Provider Demographics
NPI:1124587340
Name:SPICKELMIER, MAI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAI
Middle Name:
Last Name:SPICKELMIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PARK LANE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506
Mailing Address - Country:US
Mailing Address - Phone:832-658-5230
Mailing Address - Fax:713-473-0385
Practice Address - Street 1:400 PARK LANE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506
Practice Address - Country:US
Practice Address - Phone:832-658-5230
Practice Address - Fax:713-473-0385
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61029101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty