Provider Demographics
NPI:1316688922
Name:CORTEZ, KEVIN R
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 RESEARCH FOREST DR STE 500
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4560
Mailing Address - Country:US
Mailing Address - Phone:713-388-6410
Mailing Address - Fax:888-420-6257
Practice Address - Street 1:140 S FLOWER ST STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3467
Practice Address - Country:US
Practice Address - Phone:714-683-5876
Practice Address - Fax:888-420-6257
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-58506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst