Provider Demographics
NPI:1659838878
Name:VIDES, LUIS ENRIQUE (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:VIDES
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15634 WALLISVILLE RD STE 800 BOX #249
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-4636
Mailing Address - Country:US
Mailing Address - Phone:832-758-4992
Mailing Address - Fax:
Practice Address - Street 1:7151 OFFICE CITY DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-2736
Practice Address - Country:US
Practice Address - Phone:832-758-4992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty