Provider Demographics
NPI:1710634449
Name:KOUBA, MICHAEL (LPC-A)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KOUBA
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 TEMPLE CIR
Mailing Address - Street 2:
Mailing Address - City:HITCHCOCK
Mailing Address - State:TX
Mailing Address - Zip Code:77563-1616
Mailing Address - Country:US
Mailing Address - Phone:832-247-1133
Mailing Address - Fax:
Practice Address - Street 1:17774 CYPRESS ROSEHILL RD STE 400
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-7815
Practice Address - Country:US
Practice Address - Phone:281-205-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist