Provider Demographics
NPI:1134955248
Name:BOSTICK, JODY (LMSW)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 FONDREN RD STE 325
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5124
Mailing Address - Country:US
Mailing Address - Phone:832-771-8598
Mailing Address - Fax:713-779-5589
Practice Address - Street 1:10101 FONDREN RD STE 325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-5124
Practice Address - Country:US
Practice Address - Phone:832-771-8598
Practice Address - Fax:713-779-5589
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57367104100000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker