Healthcare Provider Details

I. General information

NPI: 1790733905
Provider Name (Legal Business Name): SENIOR CONNECTIONS OF TEXAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N HIGHWAY 290
ELGIN TX
78621-2510
US

IV. Provider business mailing address

12012 WICKCHESTER LANE SUITE 550
HOUSTON TX
77079
US

V. Phone/Fax

Practice location:
  • Phone: 832-448-2800
  • Fax: 832-448-2801
Mailing address:
  • Phone: 832-448-2800
  • Fax: 832-448-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANGEL G THORNELL
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 832-448-2800