Provider Demographics
NPI:1245762426
Name:ESSENTIAL TEXAS SPEECH THERAPY PLLC
Entity Type:Organization
Organization Name:ESSENTIAL TEXAS SPEECH THERAPY PLLC
Other - Org Name:TEXAS SPEECH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:281-969-7527
Mailing Address - Street 1:4502 RIVERSTONE BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5204
Mailing Address - Country:US
Mailing Address - Phone:281-969-7527
Mailing Address - Fax:281-969-8711
Practice Address - Street 1:4502 RIVERSTONE BLVD
Practice Address - Street 2:SUITE 701
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459
Practice Address - Country:US
Practice Address - Phone:281-969-7527
Practice Address - Fax:281-969-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1289797225100000X
TX112083225X00000X
TX109444235Z00000X
TX110471235Z00000X
TX109001235Z00000X
TX109208235Z00000X
TX261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty