Provider Demographics
NPI:1376089185
Name:SPENCER AND ASSOCIATES THERAPEUTIC ALLIANCE, PLLC
Entity Type:Organization
Organization Name:SPENCER AND ASSOCIATES THERAPEUTIC ALLIANCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:832-756-2749
Mailing Address - Street 1:12822 IVYFOREST DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2013
Mailing Address - Country:US
Mailing Address - Phone:859-816-8226
Mailing Address - Fax:859-201-1151
Practice Address - Street 1:12340 JONES RD STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3129
Practice Address - Country:US
Practice Address - Phone:832-756-2749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX394812701Medicaid
KY7100396920Medicaid