Healthcare Provider Details

I. General information

NPI: 1164062881
Provider Name (Legal Business Name): CHERYL MATLOCK RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32502 TAMINA RD STE 100
MAGNOLIA TX
77354-7451
US

IV. Provider business mailing address

7500 SAN FELIPE ST STE 900
HOUSTON TX
77063-1798
US

V. Phone/Fax

Practice location:
  • Phone: 936-206-5158
  • Fax: 346-229-1675
Mailing address:
  • Phone: 866-810-0580
  • Fax: 866-611-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-29324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: