Provider Demographics
NPI:1386203883
Name:MASK, FELICIA LUCILLE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:LUCILLE
Last Name:MASK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:FELICIA
Other - Middle Name:L
Other - Last Name:MASK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:6140 HIGHWAY 6 # 1057
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3802
Mailing Address - Country:US
Mailing Address - Phone:346-808-1572
Mailing Address - Fax:
Practice Address - Street 1:6140 HIGHWAY 6 # 1057
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3802
Practice Address - Country:US
Practice Address - Phone:346-808-1572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional