Provider Demographics
NPI:1962710590
Name:CGLUZ KIDZ
Entity type:Organization
Organization Name:CGLUZ KIDZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:EARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-754-7010
Mailing Address - Street 1:14150 WUNDERLICH DR
Mailing Address - Street 2:1405
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-3563
Mailing Address - Country:US
Mailing Address - Phone:877-754-7010
Mailing Address - Fax:866-486-3295
Practice Address - Street 1:14150 WUNDERLICH DR
Practice Address - Street 2:1405
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-3563
Practice Address - Country:US
Practice Address - Phone:877-754-7010
Practice Address - Fax:866-486-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX19312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCAQHMedicaid