Provider Demographics
NPI:1629543533
Name:QUEEN, PAUL JR
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:QUEEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 BROMPTON ST APT 525
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2221
Mailing Address - Country:US
Mailing Address - Phone:832-368-8662
Mailing Address - Fax:
Practice Address - Street 1:8702 ROCKY KNOLL LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-4896
Practice Address - Country:US
Practice Address - Phone:281-762-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner