Provider Demographics
NPI:1346942463
Name:ELEVEN 11 THERAPY LLC
Entity Type:Organization
Organization Name:ELEVEN 11 THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PIPER
Authorized Official - Middle Name:
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:972-997-1573
Mailing Address - Street 1:641 CHRISTOPHER LN
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1330
Mailing Address - Country:US
Mailing Address - Phone:972-997-1573
Mailing Address - Fax:972-848-1733
Practice Address - Street 1:641 CHRISTOPHER LN
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-1330
Practice Address - Country:US
Practice Address - Phone:972-997-1573
Practice Address - Fax:972-848-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty