Provider Demographics
NPI:1740491687
Name:SODERSTROM, MICHAEL DOUGLAS (LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:SODERSTROM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 BERING DR APT 809
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3745
Mailing Address - Country:US
Mailing Address - Phone:832-971-0025
Mailing Address - Fax:
Practice Address - Street 1:2100 BERING DR APT 809
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-3745
Practice Address - Country:US
Practice Address - Phone:832-971-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17891101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17891OtherLPC