Organization
IDIC HEALTHCARE, PLLC
Active
Organization
IDIC HEALTHCARE, PLLC
Active
Other names
IDIC HEALTHCARE, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN L HOUSEWORTH PH.D., LMFT (MANAGING MEMBER)
(832) 248-4636
Entity
Organization
Contact information
Practice address
627 W. 19TH ST., SUITE 203, HOUSTON, TX 77008-3613
(832) 248-4636
(866) 804-7241
Mailing address
5726 SAGAMORE BAY LN, RICHMOND, TX 77469-7398
(832) 248-4636
(866) 804-7241
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31626
LBSW LICENSE NUMBER
TX
01
—
5210
LMFT LICENSE NUMBER
TX
Enumeration date
04/11/2013
Last updated
09/24/2018
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