Provider Demographics
NPI:1265101422
Name:BUCKHOLTZ, LATTICIA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:LATTICIA
Middle Name:MARIE
Last Name:BUCKHOLTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GREENS PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-4532
Mailing Address - Country:US
Mailing Address - Phone:713-486-5580
Mailing Address - Fax:713-486-2721
Practice Address - Street 1:550 GREENS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-4532
Practice Address - Country:US
Practice Address - Phone:713-486-5580
Practice Address - Fax:713-486-2721
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty