Provider Demographics
NPI:1578947438
Name:RICE, DESIREE (MED, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:MED, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 MONTERREY DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4135
Mailing Address - Country:US
Mailing Address - Phone:409-351-0508
Mailing Address - Fax:800-736-2576
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 1205
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:409-338-9003
Practice Address - Fax:800-736-2576
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63396101Y00000X, 101YM0800X, 101YP2500X
TX11927101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3480279-02Medicaid