Provider Demographics
NPI:1871767525
Name:BACEK, CHRYSTINA (PHD)
Entity type:Individual
Prefix:MISS
First Name:CHRYSTINA
Middle Name:
Last Name:BACEK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 GEMINI ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2745
Mailing Address - Country:US
Mailing Address - Phone:281-956-1032
Mailing Address - Fax:281-956-1040
Practice Address - Street 1:1331 GEMINI ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2745
Practice Address - Country:US
Practice Address - Phone:281-956-1032
Practice Address - Fax:281-956-1040
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical