Healthcare Provider Details

I. General information

NPI: 1629543533
Provider Name (Legal Business Name): MR. PAUL QUEEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2018
Last Update Date: 09/11/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8702 ROCKY KNOLL LN
ROSENBERG TX
77469-4896
US

IV. Provider business mailing address

7510 BROMPTON ST APT 525
HOUSTON TX
77025-2221
US

V. Phone/Fax

Practice location:
  • Phone: 281-762-2983
  • Fax:
Mailing address:
  • Phone: 832-368-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: