Provider Demographics
NPI:1710494802
Name:INSPIRED DESIGNS HAIR SALON & BARBERSHOP & SPA LLC
Entity Type:Organization
Organization Name:INSPIRED DESIGNS HAIR SALON & BARBERSHOP & SPA LLC
Other - Org Name:INSPIRED DESIGNS HAIR SALON, HAIR LOSS & HAIR REPLACEMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CERTIFIED HAIR REPLACEMENT SPECIALI
Authorized Official - Prefix:MRS
Authorized Official - First Name:DERINA
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:CHRS
Authorized Official - Phone:254-220-9921
Mailing Address - Street 1:5214 SILTSTONE LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5815
Mailing Address - Country:US
Mailing Address - Phone:254-220-9921
Mailing Address - Fax:254-731-4232
Practice Address - Street 1:3901 E STAN SCHLUETER LOOP STE 201
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4554
Practice Address - Country:US
Practice Address - Phone:254-220-9921
Practice Address - Fax:254-731-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11781651744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1669920575OtherNPI