Healthcare Provider Details

I. General information

NPI: 1649190877
Provider Name (Legal Business Name): HEEJU WON MATUSZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 BELLA KATY DR
KATY TX
77494-6819
US

IV. Provider business mailing address

PO BOX 840237
HOUSTON TX
77284-0237
US

V. Phone/Fax

Practice location:
  • Phone: 832-717-7166
  • Fax:
Mailing address:
  • Phone: 832-717-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number95630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: