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General NPI Number Information
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NPI Number | 1508527300
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Entity Type | Organization
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Legal Business Name | THERAPY ELITE, LLC
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 2424 N PECAN ST STE 107A
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City | NACOGDOCHES
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State | TX
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Zip | 75965-3586
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Country | US
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Telephone | 936-556-1162
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Fax |
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Provider Business Mailing Address
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Address Line | 8801 E STATE HIGHWAY 7
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City | NACOGDOCHES
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State | TX
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Zip | 75961-8926
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Country | US
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Telephone | 936-556-1162
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. HOLLY HORTON RANDALL
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Credential | LCSW-S
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Telephone | 936-556-1162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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