Healthcare Provider Details

I. General information

NPI: 1093640385
Provider Name (Legal Business Name): ESSENCE AURHEANNA MACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 GRAND CENTRAL PKWY BLDG F
CONROE TX
77304-3185
US

IV. Provider business mailing address

231 INTERSTATE 45 N # 1608
CONROE TX
77304-2325
US

V. Phone/Fax

Practice location:
  • Phone: 936-286-6335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-498329
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: