Provider Demographics
NPI:1245705268
Name:CONFIDENT KIDS THERAPY LLC
Entity type:Organization
Organization Name:CONFIDENT KIDS THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:HARYANTO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP ASDCS
Authorized Official - Phone:281-616-3839
Mailing Address - Street 1:2743 IMPERIA DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8988
Mailing Address - Country:US
Mailing Address - Phone:281-616-3839
Mailing Address - Fax:346-299-5196
Practice Address - Street 1:2743 IMPERIA DR STE 103
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8988
Practice Address - Country:US
Practice Address - Phone:281-616-3839
Practice Address - Fax:346-299-5196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty