Healthcare Provider Details

I. General information

NPI: 1568062123
Provider Name (Legal Business Name): MOLLY MAUREEN CUETO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 W MAIN ST STE 2
TOMBALL TX
77375-5548
US

IV. Provider business mailing address

22730 NEWCOURT PLACE ST
TOMBALL TX
77375-1125
US

V. Phone/Fax

Practice location:
  • Phone: 832-299-8863
  • Fax: 346-336-6119
Mailing address:
  • Phone: 832-299-8863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number81520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: