Healthcare Provider Details

I. General information

NPI: 1053231175
Provider Name (Legal Business Name): CHRISTA LEIGH BEDNAREK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CONROE DR
CONROE TX
77301-1950
US

IV. Provider business mailing address

212 CONROE DR
CONROE TX
77301-1950
US

V. Phone/Fax

Practice location:
  • Phone: 281-826-2063
  • Fax:
Mailing address:
  • Phone: 281-826-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number97494
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: