Provider Demographics
NPI:1114286317
Name:THERAPY ROOM PLLC
Entity Type:Organization
Organization Name:THERAPY ROOM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:832-321-3655
Mailing Address - Street 1:810 HIGHWAY 6 S STE 211
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-4022
Mailing Address - Country:US
Mailing Address - Phone:832-321-3655
Mailing Address - Fax:832-321-3675
Practice Address - Street 1:810 HIGHWAY 6 S STE 211
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-4022
Practice Address - Country:US
Practice Address - Phone:832-321-3655
Practice Address - Fax:832-321-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084XLOtherBLUE CROSS BLUE SHIELD OF TEXAS
TXTXB156742OtherMEDICARE PART B
TX798442OtherOPTUM HEALTH, UNITED HEALTHCARE
TX304662501Medicaid
TX30466250102Medicaid
TXTXB156742OtherMEDICARE PART B