Healthcare Provider Details

I. General information

NPI: 1104733559
Provider Name (Legal Business Name): QUEENISHA CRICHLOW PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HOLCOMBE BLVD
HOUSTON TX
77030-4000
US

IV. Provider business mailing address

P O BOX 4439
HOUSTON TX
77210-4439
US

V. Phone/Fax

Practice location:
  • Phone: 713-792-6161
  • Fax:
Mailing address:
  • Phone: 713-792-2991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number40976
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: