Provider Demographics
NPI:1720633134
Name:LAICH, DUSTIN (LPC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:LAICH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 JULIE RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3144
Mailing Address - Country:US
Mailing Address - Phone:281-277-8811
Mailing Address - Fax:281-277-8827
Practice Address - Street 1:609 PARK GROVE DR STE B
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6191
Practice Address - Country:US
Practice Address - Phone:281-398-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional