Provider Demographics
NPI:1386385714
Name:MEDLOCK & ASSOCIATES COUNSELING AND CONSULTING SERVICES, PLLC
Entity type:Organization
Organization Name:MEDLOCK & ASSOCIATES COUNSELING AND CONSULTING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-876-2267
Mailing Address - Street 1:5619 MAVERICK BEND LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5096
Mailing Address - Country:US
Mailing Address - Phone:171-387-6226
Mailing Address - Fax:
Practice Address - Street 1:3000 WESLAYAN ST STE 265
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5751
Practice Address - Country:US
Practice Address - Phone:171-387-6226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health