Provider Demographics
NPI:1427068360
Name:CUELLAR, AMY KIZER (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:KIZER
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:KATHERINE
Other - Last Name:KIZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2917 PERDIDO BAY LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3461
Mailing Address - Country:US
Mailing Address - Phone:713-443-9258
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:MICHAEL E. DEBAKEY VA MEDICAL CENTER, 116MHCL-CMHP-PRRC
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-791-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX33368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program