Provider Demographics
NPI:1477662484
Name:MUKES, CATHERINE L
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:MUKES
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 1:2718 MARSHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77038-1122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:281-709-6754
Practice Address - Street 1:13810 CHAMPION FOREST DR STE 203
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-1875
Practice Address - Country:US
Practice Address - Phone:713-231-6801
Practice Address - Fax:281-709-6754
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 101YP2500X
TX19367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174735402Medicaid