Provider Demographics
NPI:1770296428
Name:MUHAMMAD, MAVIS (LCDC)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23247
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77228-3247
Mailing Address - Country:US
Mailing Address - Phone:832-453-3255
Mailing Address - Fax:
Practice Address - Street 1:5822 ELBERTA ST APT 3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77050-5450
Practice Address - Country:US
Practice Address - Phone:832-453-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10583101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)