Healthcare Provider Details

I. General information

NPI: 1386515880
Provider Name (Legal Business Name): TWO TIM ONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 MAUREL
CONROE TX
77304-3804
US

IV. Provider business mailing address

2109 MAUREL
CONROE TX
77304-3804
US

V. Phone/Fax

Practice location:
  • Phone: 832-713-6879
  • Fax:
Mailing address:
  • Phone: 832-713-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA LERMA
Title or Position: DIRECTOR
Credential:
Phone: 805-415-1536