MEDICARE: ESSENCE AURHEANNA MACON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-25-498329	TX

General Provider Information

NPI Number	:	1093640385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESSENCE AURHEANNA MACON

Provider Business Mailing Address
First Line	:	231 INTERSTATE 45 N # 1608
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 GRAND CENTRAL PKWY BLDG F
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3185
Country	:	US
Telephone Number	:	936-286-6335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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