Provider Demographics
NPI:1679823777
Name:PRECIOUS BEGINNINGS THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:PRECIOUS BEGINNINGS THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:LASHANDA
Authorized Official - Last Name:JAMISON-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-805-3355
Mailing Address - Street 1:6111 HARRISON ST
Mailing Address - Street 2:SUITE 311 C
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2969
Mailing Address - Country:US
Mailing Address - Phone:219-805-3355
Mailing Address - Fax:
Practice Address - Street 1:6111 HARRISON ST
Practice Address - Street 2:SUITE 311 C
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2969
Practice Address - Country:US
Practice Address - Phone:219-805-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002428A261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities