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General NPI Number Information
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NPI Number | 1558594614
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Entity Type | Organization
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Legal Business Name | EXECUTIVE THERAPY & EDUCATIONAL SERVICES INC
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 11601 SHADOW CREEK PKWY 111-196
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City | PEARLAND
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State | TX
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Zip | 77584-7283
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Country | US
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Telephone | 281-787-2422
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Fax |
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Provider Business Mailing Address
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Address Line | 2660 HOLLY HALL ST APT C
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City | HOUSTON
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State | TX
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Zip | 77054-4190
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRYSTAL PRATT
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Credential |
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Telephone | 281-300-5526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 103798
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License Number State | TX
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