Provider Demographics
NPI:1558028829
Name:SHANTELL'S PRO SCREENINGS
Entity Type:Organization
Organization Name:SHANTELL'S PRO SCREENINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-480-1412
Mailing Address - Street 1:1601 HAVARD RD
Mailing Address - Street 2:
Mailing Address - City:HUFFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:77336-4195
Mailing Address - Country:US
Mailing Address - Phone:832-480-1412
Mailing Address - Fax:
Practice Address - Street 1:2001 TIMBERLOCH PL STE 500
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1375
Practice Address - Country:US
Practice Address - Phone:281-720-3251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date: