Provider Demographics
NPI:1205494028
Name:SPENCER, KEYONNE (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:KEYONNE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 COUNCIL GROVE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-5516
Mailing Address - Country:US
Mailing Address - Phone:713-538-5210
Mailing Address - Fax:
Practice Address - Street 1:3845 CYPRESS CREEK PKWY STE 315
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3519
Practice Address - Country:US
Practice Address - Phone:832-509-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX400432701Medicaid