=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174242242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATALYST THERAPY & CONSULTING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2022
-----------------------------------------------------
Last Update Date | 08/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 COUNTY ROAD 3581
-----------------------------------------------------
City | PARADISE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76073-5013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-510-8995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 COUNTY ROAD 3581
-----------------------------------------------------
City | PARADISE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76073-5013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-510-8995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | FELICIA GENTRY
-----------------------------------------------------
Credential | M.A., CCC-SLP
-----------------------------------------------------
Telephone | 318-510-8995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------