Provider Information for 1013643253
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ALISTER BLUCKER LPC, LCDC
Sex: Male
NPI: 1013643253
Last Updated: 2022-07-29
Certification Date: 2022-07-29
Certification Date: 2022-07-29
Details
| Name | Value | ||||||||||||||
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| NPI | 1013643253 | ||||||||||||||
| Enumeration Date | 2022-07-29 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 15710 BROOKVILLA DR HOUSTON, TX 77059-5909 United States Phone: 281-508-0157 | Fax: | ||||||||||||||
| Primary Practice Address | 15710 BROOKVILLA DR HOUSTON, TX 77059-5909 United States Phone: 281-508-0157 | Fax: | ||||||||||||||
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