Healthcare Provider Details

I. General information

NPI: 1730025420
Provider Name (Legal Business Name): SHOOTING STARS EARLY INTERVENTION AND THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 SESSIONS RD
ELGIN SC
29045-9416
US

IV. Provider business mailing address

5900 BALCONES DR STE 100
AUSTIN TX
78731-4298
US

V. Phone/Fax

Practice location:
  • Phone: 803-420-8492
  • Fax:
Mailing address:
  • Phone: 803-420-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIA NELSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 803-420-8492