Provider Demographics
NPI:1386044949
Name:SPAIN, KEVIN (MAMFC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:SPAIN
Suffix:
Gender:M
Credentials:MAMFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 AUGUSTA DR
Mailing Address - Street 2:APT 237
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3144
Mailing Address - Country:US
Mailing Address - Phone:832-712-5704
Mailing Address - Fax:
Practice Address - Street 1:11999 KATY FWY
Practice Address - Street 2:SUITE 530
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1611
Practice Address - Country:US
Practice Address - Phone:832-712-5704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional