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1725 E Main St League City TX 77573-4146 | |
| (281) 332-3300 | |
| (281) 332-0039 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1725 E Main St, League City, Texas |
| Authorized Official Name and Position | Larna Vee Loeckle (OWNER) |
| Authorized Official Contact | 2813323300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1725 East Main Street League City TX 77573 Ph: (281) 332-3300 | 1725 E Main St League City TX 77573-4146 Ph: (281) 332-3300 |
| NPI Number | 1184809378 |
|---|---|
| Provider Enumeration Date | 01/07/2008 |
| Last Update Date | 01/07/2008 |
| Medicare PECOS PAC ID | 4981140811 |
|---|---|
| Medicare Enrollment ID | O20240726002076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184809378 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 12291 (Texas) | Primary |
| Provider Name | Larna Vee Loeckle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417962192 PECOS PAC ID: 5890231724 Enrollment ID: I20240726002328 |
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