Provider Demographics
NPI:1417211269
Name:DAVIS, SRLESTINE T (MED,LPC,CSC,CI)
Entity Type:Individual
Prefix:MRS
First Name:SRLESTINE
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED,LPC,CSC,CI
Other - Prefix:MRS
Other - First Name:LESTINE
Other - Middle Name:T
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED,LPC,CSC,LCDC
Mailing Address - Street 1:12401 S POST OAK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-2020
Mailing Address - Country:US
Mailing Address - Phone:713-551-8655
Mailing Address - Fax:
Practice Address - Street 1:12401 S POST OAK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-2020
Practice Address - Country:US
Practice Address - Phone:713-551-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGRADES EC-12101Y00000X
TX6979101YA0400X
TX65349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)