Provider Demographics
| NPI: | 1013991017 |
|---|---|
| Name: | EASTER SEALS CENTRAL TEXAS, INC. |
| Entity Type: | Organization |
| Organization Name: | EASTER SEALS CENTRAL TEXAS, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CAROL |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | KHOURY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 212-727-4270 |
| Mailing Address - Street 1: | 2324 RIDGEPOINT DR STE F1 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | AUSTIN |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 78754-5214 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 512-615-6800 |
| Mailing Address - Fax: | 512-615-7121 |
| Practice Address - Street 1: | 2324 RIDGEPOINT DR STE F1 |
| Practice Address - Street 2: | |
| Practice Address - City: | AUSTIN |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78754-5214 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 512-615-6800 |
| Practice Address - Fax: | 512-615-7121 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-12-02 |
| Last Update Date: | 2023-07-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TX | 18436 | 101YP2500X |
| 103K00000X, 171M00000X, 2251P0200X, 225XP0200X, 235Z00000X, 252Y00000X, 261QD1600X, 261QR0401X | ||
| TX | DT02978 | 133V00000X |
| TX | 51670 | 231H00000X, 237600000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 237600000X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | Group - Multi-Specialty | |
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 0082CM | Other | BLUE CROSS PROVIDER GROUP |
| TX | 126129901 | Medicaid | |
| TX | 004760702 | Medicaid | |
| TX | 021286202 | Medicaid | |
| TX | 021286201 | Medicaid | |
| TX | 021286204 | Medicaid | |
| TX | 172268801 | Medicaid | |
| TX | 021286202 | Medicaid | |
| TX | 172268801 | Medicaid | |
| TX | 0A4544 | Medicare PIN |
