Provider Demographics
NPI:1558465195
Name:KRISTINA FERNANDEZ, L.P.C.
Entity Type:Organization
Organization Name:KRISTINA FERNANDEZ, L.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MORAN-FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-955-0050
Mailing Address - Street 1:9950 CYPRESSWOOD DR
Mailing Address - Street 2:#160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3414
Mailing Address - Country:US
Mailing Address - Phone:281-955-0050
Mailing Address - Fax:281-955-0199
Practice Address - Street 1:9950 CYPRESSWOOD DR
Practice Address - Street 2:#160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3414
Practice Address - Country:US
Practice Address - Phone:281-955-0050
Practice Address - Fax:281-955-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154791102Medicaid