1659838878 NPI number — MR. LUIS ENRIQUE VIDES MED., LPC

Table of content: MR. LUIS ENRIQUE VIDES MED., LPC (NPI 1659838878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659838878 NPI number — MR. LUIS ENRIQUE VIDES MED., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIDES
Provider First Name:
LUIS
Provider Middle Name:
ENRIQUE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MED., LPC
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:
1659838878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15634 WALLISVILLE RD STE 800 BOX #249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77049-4636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-758-4992
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7151 OFFICE CITY DR STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77087-2736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-758-4992
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
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Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  77377 , 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)





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