Healthcare Provider Details

I. General information

NPI: 1770120719
Provider Name (Legal Business Name): AMAZING & CREATIVE THERAPY ON THE SPECTRUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 04/27/2021
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14058 MEMORIAL DR
HOUSTON TX
77079-6848
US

IV. Provider business mailing address

1307 SHERWOOD POINT LN
HOUSTON TX
77043-2857
US

V. Phone/Fax

Practice location:
  • Phone: 281-752-0403
  • Fax: 281-752-0502
Mailing address:
  • Phone: 832-758-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. HYESHIN H BOUWHUIS
Title or Position: OWNER
Credential:
Phone: 832-758-0090