Provider Demographics
NPI:1245741180
Name:PONTELLO, MICHAEL (LMFT-S)
Entity Type:Individual
Prefix:MS
First Name:MICHAEL
Middle Name:
Last Name:PONTELLO
Suffix:
Gender:F
Credentials:LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3104
Mailing Address - Country:US
Mailing Address - Phone:713-526-8390
Mailing Address - Fax:
Practice Address - Street 1:2990 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3104
Practice Address - Country:US
Practice Address - Phone:713-526-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist