Provider Demographics
NPI:1013704592
Name:THOMPSON, SERENA LUDY
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:LUDY
Last Name:THOMPSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11906 BALD MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-1106
Mailing Address - Country:US
Mailing Address - Phone:832-725-4773
Mailing Address - Fax:
Practice Address - Street 1:11906 BALD MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-1106
Practice Address - Country:US
Practice Address - Phone:832-725-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health