Provider Demographics
NPI:1013274463
Name:MICAH, THALIA LAEL (LAC, LMT, MTI)
Entity type:Individual
Prefix:DR
First Name:THALIA
Middle Name:LAEL
Last Name:MICAH
Suffix:
Gender:F
Credentials:LAC, LMT, MTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 S GESSNER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3774
Mailing Address - Country:US
Mailing Address - Phone:832-832-1237
Mailing Address - Fax:832-363-5588
Practice Address - Street 1:2950 S GESSNER RD STE 205
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3774
Practice Address - Country:US
Practice Address - Phone:832-382-1237
Practice Address - Fax:832-344-3611
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02952171100000X
171R00000X, 374J00000X, 376J00000X, 171400000X
FLMA65758225700000X
TXMT131572225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No171100000XOther Service ProvidersAcupuncturist
No171R00000XOther Service ProvidersInterpreter
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula
No376J00000XNursing Service Related ProvidersHomemaker