Provider Demographics
NPI:1699060863
Name:MADORSKY, KRISTINE J (M ED, LPC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:J
Last Name:MADORSKY
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 SMITHDALE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-6723
Mailing Address - Country:US
Mailing Address - Phone:713-498-1054
Mailing Address - Fax:
Practice Address - Street 1:820 GESSNER RD
Practice Address - Street 2:SUITE 1560
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4289
Practice Address - Country:US
Practice Address - Phone:713-498-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional