Provider Demographics
NPI:1831663962
Name:GRICE, TEAIRRA NIANGEL
Entity Type:Individual
Prefix:
First Name:TEAIRRA
Middle Name:NIANGEL
Last Name:GRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12811 GREENWOOD FOREST DR APT 512
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-1624
Mailing Address - Country:US
Mailing Address - Phone:502-471-9629
Mailing Address - Fax:
Practice Address - Street 1:16835 DEER CREEK DR STE 220
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4895
Practice Address - Country:US
Practice Address - Phone:281-290-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician