1912901349 NPI number — TOM W CAPO MA, LPC, LMFT, LCDC

Table of content: TOM W CAPO MA, LPC, LMFT, LCDC (NPI 1912901349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912901349 NPI number — TOM W CAPO MA, LPC, LMFT, LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAPO
Provider First Name:
TOM
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, LMFT, 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:
1912901349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18333 EGRET BAY BLVD
Provider Second Line Business Mailing Address:
STE 305
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77058-3265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-333-5740
Provider Business Mailing Address Fax Number:
281-333-4013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18333 EGRET BAY BLVD
Provider Second Line Business Practice Location Address:
STE 305
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77058-3265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-333-5740
Provider Business Practice Location Address Fax Number:
281-333-4013
Provider Enumeration Date:
06/13/2005

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:  2008 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: 09975 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 001751-041825 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 95460401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: LC 09975 . This is a "LPC LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: LCDC 2008 . This is a "LCDC LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: LMFT 001751-041825 . This is a "LMFT LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com