Provider Demographics
NPI:1225046634
Name:CLEAR LAKE COUNSELING SERVICESPCINC
Entity Type:Organization
Organization Name:CLEAR LAKE COUNSELING SERVICESPCINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LADDEL
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:281-289-0393
Mailing Address - Street 1:17629 EL CAMINO REAL
Mailing Address - Street 2:190
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2901
Mailing Address - Country:US
Mailing Address - Phone:281-280-0393
Mailing Address - Fax:281-280-0123
Practice Address - Street 1:17629 EL CAMINO REAL
Practice Address - Street 2:190
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2901
Practice Address - Country:US
Practice Address - Phone:281-280-0393
Practice Address - Fax:281-280-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX752A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty