Provider Demographics
NPI:1689703415
Name:LETHERMON, VERDI R (PHD)
Entity Type:Individual
Prefix:DR
First Name:VERDI
Middle Name:R
Last Name:LETHERMON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 VETERANS MEMORIAL DR
Mailing Address - Street 2:STE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2037
Mailing Address - Country:US
Mailing Address - Phone:281-877-1985
Mailing Address - Fax:281-877-1995
Practice Address - Street 1:12701 VETERANS MEMORIAL DR
Practice Address - Street 2:STE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2037
Practice Address - Country:US
Practice Address - Phone:281-877-1985
Practice Address - Fax:281-877-1995
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4382OtherLICENSE NUMBER