Provider Demographics
NPI:1477978757
Name:BEAR FRUIT SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:BEAR FRUIT SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CAREEM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCBEAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:832-454-1911
Mailing Address - Street 1:9889 CYPRESSWOOD DR APT 3306
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3972
Mailing Address - Country:US
Mailing Address - Phone:832-454-1911
Mailing Address - Fax:
Practice Address - Street 1:9889 CYPRESSWOOD DR APT 3306
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3972
Practice Address - Country:US
Practice Address - Phone:832-454-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0801918882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty