Healthcare Provider Details

I. General information

NPI: 1053146183
Provider Name (Legal Business Name): TED CARE III LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 EXECUTIVE DR STE 500
IRVING TX
75038-2729
US

IV. Provider business mailing address

15603 KUYKENDAHL RD STE 300
HOUSTON TX
77090-3656
US

V. Phone/Fax

Practice location:
  • Phone: 612-669-6355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIK LAINE
Title or Position: OWNER
Credential:
Phone: 612-669-6355