Provider Demographics
NPI:1124395504
Name:SUNSET BAY SPEECH THERAPY SERVICES
Entity Type:Organization
Organization Name:SUNSET BAY SPEECH THERAPY SERVICES
Other - Org Name:FAITH JOHNSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-881-0448
Mailing Address - Street 1:13419 SUNSET BAY LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2174
Mailing Address - Country:US
Mailing Address - Phone:281-881-0448
Mailing Address - Fax:713-340-0355
Practice Address - Street 1:10039 BISSONNET ST STE 112
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7838
Practice Address - Country:US
Practice Address - Phone:713-777-1944
Practice Address - Fax:713-777-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215130001Medicaid