Provider Demographics
NPI:1710242250
Name:DAVID, JOSE (LPC , LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:DAVID
Suffix:
Gender:M
Credentials:LPC , LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2519
Mailing Address - Country:US
Mailing Address - Phone:832-549-4054
Mailing Address - Fax:
Practice Address - Street 1:407 HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2519
Practice Address - Country:US
Practice Address - Phone:832-549-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66305101YP2500X
TX201443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710242250Medicaid