Provider Demographics
NPI:1639925696
Name:HAIR LOSS MANAGEMENT CENTER OF HOUSTON
Entity type:Organization
Organization Name:HAIR LOSS MANAGEMENT CENTER OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYNESSA
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-505-7444
Mailing Address - Street 1:11403 BARKER CYPRESS RD STE J
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5398
Mailing Address - Country:US
Mailing Address - Phone:310-505-7444
Mailing Address - Fax:
Practice Address - Street 1:13100 WORTHAM CENTER DR FL 3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5625
Practice Address - Country:US
Practice Address - Phone:310-505-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073369104Medicaid