Provider Demographics
NPI:1568855997
Name:MCCLOUD, DAISEY M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DAISEY
Middle Name:M
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 1675
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553
Mailing Address - Country:US
Mailing Address - Phone:409-740-4537
Mailing Address - Fax:
Practice Address - Street 1:2200 SPACE PARK DR STE 240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3881
Practice Address - Country:US
Practice Address - Phone:281-645-5264
Practice Address - Fax:281-779-8619
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional