Provider Demographics
NPI:1396367397
Name:WEBSTER, SUKURA Q
Entity Type:Individual
Prefix:
First Name:SUKURA
Middle Name:Q
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22311 BRIDGESTONE PALM CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-2891
Mailing Address - Country:US
Mailing Address - Phone:619-913-3074
Mailing Address - Fax:
Practice Address - Street 1:22311 BRIDGESTONE PALM CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-2891
Practice Address - Country:US
Practice Address - Phone:619-913-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82814101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor