Provider Demographics
NPI:1699439703
Name:AMADOR, CRISTIAN MATEO (MA)
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:MATEO
Last Name:AMADOR
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 CAMDON DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4260
Mailing Address - Country:US
Mailing Address - Phone:281-777-6579
Mailing Address - Fax:
Practice Address - Street 1:2743 SMITH RANCH RD STE 801
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5204
Practice Address - Country:US
Practice Address - Phone:210-693-0943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional