Provider Demographics
NPI:1831458058
Name:UPDIKE-CHILCOAT, CONSTANCE MARIE (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:MARIE
Last Name:UPDIKE-CHILCOAT
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15314 BONITA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1358
Mailing Address - Country:US
Mailing Address - Phone:281-460-2320
Mailing Address - Fax:281-575-6693
Practice Address - Street 1:15314 BONITA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1358
Practice Address - Country:US
Practice Address - Phone:281-460-2320
Practice Address - Fax:281-575-6693
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist