Provider Demographics
NPI:1427490796
Name:FALLICK, LETICIA O (LPC)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:O
Last Name:FALLICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13707 ALCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7010
Mailing Address - Country:US
Mailing Address - Phone:832-423-0543
Mailing Address - Fax:713-467-5142
Practice Address - Street 1:11000 RICHMOND AVE STE 330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4700
Practice Address - Country:US
Practice Address - Phone:713-400-7400
Practice Address - Fax:713-974-0870
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional