Provider Demographics
NPI:1922440957
Name:EDUCARE THERAPY, LLC
Entity Type:Organization
Organization Name:EDUCARE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:817-717-3800
Mailing Address - Street 1:11751 ALTA VISTA RD
Mailing Address - Street 2:STE 303
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6441
Mailing Address - Country:US
Mailing Address - Phone:817-717-3800
Mailing Address - Fax:888-234-6493
Practice Address - Street 1:11751 ALTA VISTA RD
Practice Address - Street 2:STE 303
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6441
Practice Address - Country:US
Practice Address - Phone:817-717-3800
Practice Address - Fax:888-234-6493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
TX107073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314560901Medicaid