Provider Demographics
NPI:1619431160
Name:MUSTAFA, EHAB A (LPC-I)
Entity Type:Individual
Prefix:DR
First Name:EHAB
Middle Name:A
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SEASCAPE LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6171
Mailing Address - Country:US
Mailing Address - Phone:469-363-1009
Mailing Address - Fax:
Practice Address - Street 1:212 SEASCAPE LN
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6171
Practice Address - Country:US
Practice Address - Phone:469-363-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty