Healthcare Provider Details

I. General information

NPI: 1962710590
Provider Name (Legal Business Name): CGLUZ KIDZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 WUNDERLICH DR 1405
HOUSTON TX
77069-3563
US

IV. Provider business mailing address

14150 WUNDERLICH DR 1405
HOUSTON TX
77069-3563
US

V. Phone/Fax

Practice location:
  • Phone: 877-754-7010
  • Fax: 866-486-3295
Mailing address:
  • Phone: 877-754-7010
  • Fax: 866-486-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTX19312
License Number StateTX

VIII. Authorized Official

Name: MS. MELISSA EARL
Title or Position: PROFESSIONAL COUNSELOR
Credential:
Phone: 877-754-7010