Healthcare Provider Details

I. General information

NPI: 1063900074
Provider Name (Legal Business Name): THERAPY AND BEYOND OF SOUTH TEXAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32207 TAMINA RD
MAGNOLIA TX
77354-2556
US

IV. Provider business mailing address

2020 E HEBRON PKWY STE 110
CARROLLTON TX
75007-1609
US

V. Phone/Fax

Practice location:
  • Phone: 713-364-4654
  • Fax: 469-575-3002
Mailing address:
  • Phone: 469-892-7500
  • Fax: 469-575-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SEAN CRONE
Title or Position: COO
Credential:
Phone: 469-892-7500