MEDICARE: POLKA DOT JOURNEY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	251S00000X	Community/Behavioral Health Agency
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1194587402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLKA DOT JOURNEY LLC

Provider Business Mailing Address
First Line	:	9902 TANGIERS RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-7544
Country	:	US
Telephone Number	:	346-229-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	9902 TANGIERS RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-7544
Country	:	US
Telephone Number	:	346-229-7788
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	STEPHANIE MICHELLE BRACEY
Credential	:
Telephone Number	:	346-229-7788

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	12/24/2025

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Directions to “POLKA DOT JOURNEY LLC ” Practice Location

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