Provider Demographics
NPI:1689103319
Name:MOON LILY THERAPY PPLC
Entity Type:Organization
Organization Name:MOON LILY THERAPY PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:713-562-2572
Mailing Address - Street 1:2110 SHEARN ST UNIT F412110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3962
Mailing Address - Country:US
Mailing Address - Phone:713-562-2572
Mailing Address - Fax:713-932-6713
Practice Address - Street 1:2110 SHEARN ST UNIT F41
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3972
Practice Address - Country:US
Practice Address - Phone:713-562-2572
Practice Address - Fax:713-932-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528750OtherBCBSTX