Provider Demographics
NPI:1306530670
Name:LAVAN,, DWIGHT D (LCDC, LCPC)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:D
Last Name:LAVAN,
Suffix:
Gender:M
Credentials:LCDC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S LOOP W STE 322
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2886
Mailing Address - Country:US
Mailing Address - Phone:713-816-6646
Mailing Address - Fax:346-450-6962
Practice Address - Street 1:2600 S LOOP W STE 322
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2886
Practice Address - Country:US
Practice Address - Phone:713-816-6646
Practice Address - Fax:346-450-6962
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
101YP1600X
TX14456172V00000X
3285687101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No172V00000XOther Service ProvidersCommunity Health Worker