Individual
KEISHAY IZZARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
E.D
Contact information
Practice address
12955 WILLOW PLACE DR W, HOUSTON, TX 77070-5651
(209) 354-6234
Mailing address
12955 WILLOW PLACE DR W, HOUSTON, TX 77070-5651
(209) 354-6234
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
106H00000X
Marriage & Family Therapist
Primary
5682948
CA
221700000X
Art Therapist
—
—
222Q00000X
Developmental Therapist
—
—
225600000X
Dance Therapist
—
—
225700000X
Massage Therapist
—
—
225A00000X
Music Therapist
—
—
347C00000X
Private Vehicle
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Enumeration date
04/29/2014
Last updated
08/04/2014
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