Provider Demographics
NPI:1639476351
Name:UNIVERSITY OF HOUSTON, CLEAR LAKE
Entity type:Organization
Organization Name:UNIVERSITY OF HOUSTON, CLEAR LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:281-283-3452
Mailing Address - Street 1:2700 BAY AREA BLVD.
Mailing Address - Street 2:MC 245
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1098
Mailing Address - Country:US
Mailing Address - Phone:281-283-3437
Mailing Address - Fax:
Practice Address - Street 1:2700 BAY AREA BLVD.
Practice Address - Street 2:MC 245
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1098
Practice Address - Country:US
Practice Address - Phone:281-283-3437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health