Idic Healthcare, PLLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

IDIC HEALTHCARE, PLLC

Practice address

627 W. 19TH St.
Suite 203
Houston, TX 77008-3613

Phone

(832) 248-4636

Fax

(866) 804-7241

NPI assigned

Apr 11, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Steven L Houseworth, PH.D., LMFT

Title

Managing Member

Phone

(832) 248-4636

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• IDIC HEALTHCARE, PLLC Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537747200000",
    "number": "1174966915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5726 SAGAMORE BAY LN",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774697398",
            "telephone_number": "832-248-4636",
            "fax_number": "866-804-7241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 W. 19TH ST.",
            "address_2": "SUITE 203",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770083613",
            "telephone_number": "832-248-4636",
            "fax_number": "866-804-7241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDIC HEALTHCARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-11",
        "last_updated": "2018-09-24",
        "status": "A",
        "authorized_official_last_name": "HOUSEWORTH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "832-248-4636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LBSW LICENSE NUMBER",
            "identifier": "31626",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMFT LICENSE NUMBER",
            "identifier": "5210",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IDIC HEALTHCARE, PLLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "IDIC HEALTHCARE, PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Multi-Specialty Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Multi-Specialty Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.