Provider Demographics
NPI:1669227336
Name:LAZO, MARISELA GOMEZ
Entity type:Individual
Prefix:
First Name:MARISELA
Middle Name:GOMEZ
Last Name:LAZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 STELLA LINK RD # 466
Mailing Address - Street 2:
Mailing Address - City:WEST UNIVERSITY PLACE
Mailing Address - State:TX
Mailing Address - Zip Code:77005-4342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 NORTH LOOP W STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8826
Practice Address - Country:US
Practice Address - Phone:832-304-8547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX622621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical