Provider Demographics
NPI:1811286065
Name:MEDLOCK, CELINE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CELINE
Middle Name:
Last Name:MEDLOCK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 KATY FWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1903
Mailing Address - Country:US
Mailing Address - Phone:713-828-0593
Mailing Address - Fax:713-784-4040
Practice Address - Street 1:11511 KATY FWY
Practice Address - Street 2:SUITE 410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1903
Practice Address - Country:US
Practice Address - Phone:713-828-0593
Practice Address - Fax:713-784-4040
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional