=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114323870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE THERAPY VILLAGE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2014
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14815 CYPRESS NORTH HOUSTON RD STE A
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-6182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-477-9500
-----------------------------------------------------
Fax | 281-477-9563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13510 CASTLECOMBE DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77044-4953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-477-9500
-----------------------------------------------------
Fax | 281-477-9563
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. MARY BETH HANCOCK
-----------------------------------------------------
Credential | D/OTR
-----------------------------------------------------
Telephone | 832-309-6055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 261QR0401X
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------