Provider Demographics
NPI:1235855693
Name:FLORES, ISMAEL F III (LCDC)
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:F
Last Name:FLORES
Suffix:III
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 AIRPORT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5759
Mailing Address - Country:US
Mailing Address - Phone:281-239-1445
Mailing Address - Fax:281-239-0828
Practice Address - Street 1:535 FM 359 RD S
Practice Address - Street 2:
Practice Address - City:BROOKSHIRE
Practice Address - State:TX
Practice Address - Zip Code:77423-9006
Practice Address - Country:US
Practice Address - Phone:281-375-5300
Practice Address - Fax:281-239-0828
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15779101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)