Provider Demographics
NPI:1891391421
Name:COULTER, JOSEPH DONALD (LCDC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DONALD
Last Name:COULTER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 MOONSHADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1825
Mailing Address - Country:US
Mailing Address - Phone:281-726-7475
Mailing Address - Fax:
Practice Address - Street 1:5310 MOONSHADOWS DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-1825
Practice Address - Country:US
Practice Address - Phone:281-726-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)