Provider Demographics
NPI:1144062902
Name:MATOS-CUNNINGHAM, KEYLYNNE
Entity type:Individual
Prefix:
First Name:KEYLYNNE
Middle Name:
Last Name:MATOS-CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 LEONA ST APT 2116
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1598
Mailing Address - Country:US
Mailing Address - Phone:704-773-4578
Mailing Address - Fax:
Practice Address - Street 1:24102 PRAIRIE GLEN LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3300
Practice Address - Country:US
Practice Address - Phone:713-331-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health