Provider Demographics
NPI:1205611209
Name:TLC PSYCHOTHERAPY AND CLINICAL SUPERVISION, PLLC
Entity type:Organization
Organization Name:TLC PSYCHOTHERAPY AND CLINICAL SUPERVISION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARKITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-534-3552
Mailing Address - Street 1:13610 FOUNTAIN MIST DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3777
Mailing Address - Country:US
Mailing Address - Phone:832-534-3552
Mailing Address - Fax:
Practice Address - Street 1:13610 FOUNTAIN MIST DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3777
Practice Address - Country:US
Practice Address - Phone:832-534-3552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty