Provider Demographics
NPI:1780355537
Name:DOROUGH, MEKIELA (MS, LPC)
Entity type:Individual
Prefix:
First Name:MEKIELA
Middle Name:
Last Name:DOROUGH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 BEAR SPRING DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24200 VIA MAZZINI WAY STE 250
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-3439
Practice Address - Country:US
Practice Address - Phone:832-906-8743
Practice Address - Fax:832-810-2432
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health