Individual
KENNETH MEDLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC, CEAP
Contact information
Practice address
9950 TOWN PARK DR APT 1202, HOUSTON, TX 77036-2356
(832) 754-8001
Mailing address
9950 TOWN PARK DR APT 1202, HOUSTON, TX 77036-2356
(832) 754-8001
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5845
TX
101YP2500X
Professional Counselor
33084
TX
Other
Enumeration date
12/29/2022
Last updated
12/29/2022
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