Provider Demographics
NPI:1508527300
Name:THERAPY ELITE, LLC
Entity Type:Organization
Organization Name:THERAPY ELITE, LLC
Other - Org Name:THERAPY ELITE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:HORTON
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:936-556-1162
Mailing Address - Street 1:8801 E STATE HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-8926
Mailing Address - Country:US
Mailing Address - Phone:936-556-1162
Mailing Address - Fax:
Practice Address - Street 1:2424 N PECAN ST STE 107A
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-3586
Practice Address - Country:US
Practice Address - Phone:936-556-1162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty