Provider Demographics
NPI:1518532597
Name:KAKOS, MARK (LCDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KAKOS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9918 YEARLING PL
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-2020
Mailing Address - Country:US
Mailing Address - Phone:412-608-4322
Mailing Address - Fax:
Practice Address - Street 1:9918 YEARLING PL
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-2020
Practice Address - Country:US
Practice Address - Phone:412-608-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14548101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14548OtherLCDC