Healthcare Provider Details

I. General information

NPI: 1821302704
Provider Name (Legal Business Name): CULLEN PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12805 CULLEN BLVD SUITE D
HOUSTON TX
77047-3759
US

IV. Provider business mailing address

12805 CULLEN BLVD SUITE D
HOUSTON TX
77047-3759
US

V. Phone/Fax

Practice location:
  • Phone: 713-738-6695
  • Fax: 713-738-6690
Mailing address:
  • Phone: 713-738-6695
  • Fax: 713-738-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberH0554
License Number StateTX

VIII. Authorized Official

Name: SHAYNA P LEE
Title or Position: PHYSICIAN
Credential: MD
Phone: 713-738-6695