MEDICARE: BEAUTY OF IMPERFECTION, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77752	OTHER	TX	LPC LICENSE

General Provider Information

NPI Number	:	1528777893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTY OF IMPERFECTION, PLLC

Provider Business Mailing Address
First Line	:	4502 RIVERSTONE BLVD STE 702
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5210
Country	:	US
Telephone Number	:	281-900-6243
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 RIVERSTONE BLVD STE 702
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5210
Country	:	US
Telephone Number	:	281-900-6243
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CELESTE LOTT
Credential	:
Telephone Number	:	281-900-6243

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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