Provider Demographics
NPI:1790733905
Name:SENIOR CONNECTIONS OF TEXAS PLLC
Entity Type:Organization
Organization Name:SENIOR CONNECTIONS OF TEXAS PLLC
Other - Org Name:SENIOR CONNECTIONS OF HOUSTON PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:THORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-448-2800
Mailing Address - Street 1:12012 WICKCHESTER LANE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079
Mailing Address - Country:US
Mailing Address - Phone:832-448-2800
Mailing Address - Fax:832-448-2801
Practice Address - Street 1:605 N HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2510
Practice Address - Country:US
Practice Address - Phone:832-448-2800
Practice Address - Fax:832-448-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCG4009OtherRAIL ROAD MEDICARE
TX0074AEOtherBCBS
TXCG4009OtherRAIL ROAD MEDICARE