1215232053 NPI number — MR. STEVEN M VESTAL LPC, LCDC

Table of content: MR. STEVEN M VESTAL LPC, LCDC (NPI 1215232053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215232053 NPI number — MR. STEVEN M VESTAL LPC, LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VESTAL
Provider First Name:
STEVEN
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215232053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13845 CORPUS CHRISTI ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77015-3961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-637-8228
Provider Business Mailing Address Fax Number:
713-344-0431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13845 CORPUS CHRISTI ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77015-3961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-637-8228
Provider Business Practice Location Address Fax Number:
713-344-0431
Provider Enumeration Date:
01/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  11274 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 68871 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 303664201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12162756 . This is a "CAQH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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