Provider Demographics
NPI:1528249190
Name:ANTELIZ, JORGE LUIS (LPC;LMHC; LCDC)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:LUIS
Last Name:ANTELIZ
Suffix:
Gender:M
Credentials:LPC;LMHC; LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 BLUE MIST DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4821
Mailing Address - Country:US
Mailing Address - Phone:713-732-7794
Mailing Address - Fax:
Practice Address - Street 1:10060 FUQUA STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089
Practice Address - Country:US
Practice Address - Phone:713-948-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9296101YA0400X
NY476-1101YM0800X
TX69402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health