Healthcare Provider Details

I. General information

NPI: 1750138053
Provider Name (Legal Business Name): NICOLE KUTTSCHREUTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 FRY RD STE 103
CYPRESS TX
77433-0022
US

IV. Provider business mailing address

12311 MILLVAN DR
HOUSTON TX
77070-4870
US

V. Phone/Fax

Practice location:
  • Phone: 832-653-4314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: