Healthcare Provider Details

I. General information

NPI: 1396008710
Provider Name (Legal Business Name): CYE GA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date: 11/25/2025
Reactivation Date: 12/09/2025

III. Provider practice location address

2626 S LOOP W STE 615
HOUSTON TX
77054-5613
US

IV. Provider business mailing address

2626 S LOOP W STE 615
HOUSTON TX
77054-5613
US

V. Phone/Fax

Practice location:
  • Phone: 281-937-3267
  • Fax: 855-696-9590
Mailing address:
  • Phone: 281-937-3267
  • Fax: 855-696-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MONIQUE TERESA CORTES
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 832-419-1053