Healthcare Provider Details

I. General information

NPI: 1720370224
Provider Name (Legal Business Name): LIFTING YOUNG MINDS TO NEW HEIGHTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GENESIS BLVD STE D
WEBSTER TX
77598-1636
US

IV. Provider business mailing address

210 GENESIS BLVD STE D
WEBSTER TX
77598-1636
US

V. Phone/Fax

Practice location:
  • Phone: 832-569-4316
  • Fax: 832-838-4458
Mailing address:
  • Phone: 832-569-4316
  • Fax: 832-838-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number104437
License Number StateTX

VIII. Authorized Official

Name: STEPHANIE CATHERINE PILSNER
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S., SLP-CCC, BCBA
Phone: 832-569-4316