Provider Demographics
NPI:1760916233
Name:L J COUNSELING AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:L J COUNSELING AND COMMUNITY SERVICES
Other - Org Name:LIFE'S JOURNEY COUNSELING AND COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:CHANELL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S
Authorized Official - Phone:832-814-2688
Mailing Address - Street 1:8300 CYPRESS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5654
Mailing Address - Country:US
Mailing Address - Phone:281-746-2704
Mailing Address - Fax:832-413-5072
Practice Address - Street 1:19123 DAWNTREADER DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4323
Practice Address - Country:US
Practice Address - Phone:281-746-2704
Practice Address - Fax:832-413-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287170902Medicaid