Healthcare Provider Details

I. General information

NPI: 1861213639
Provider Name (Legal Business Name): AMBER KRISTINE BAYNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER GROLL

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14930 MUESCHKE RD STE 100
CYPRESS TX
77433-0980
US

IV. Provider business mailing address

14930 MUESCHKE RD STE 100
CYPRESS TX
77433-0980
US

V. Phone/Fax

Practice location:
  • Phone: 346-206-3992
  • Fax: 832-652-3626
Mailing address:
  • Phone: 346-206-3992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103564
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: