Provider Demographics
NPI:1275697617
Name:LITTLE, DANA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 AVENUE Q 1/2
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-5168
Mailing Address - Country:US
Mailing Address - Phone:409-599-7683
Mailing Address - Fax:281-947-3122
Practice Address - Street 1:5509 AVENUE Q 1/2
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-5168
Practice Address - Country:US
Practice Address - Phone:409-599-7683
Practice Address - Fax:281-947-3122
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43647106H00000X
TX201517106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339616002Medicaid
TX339616001Medicaid