Provider Demographics
NPI:1245941871
Name:TABA&ST LLC
Entity type:Organization
Organization Name:TABA&ST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-947-8925
Mailing Address - Street 1:1313 W. PARKWOOD, AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546
Mailing Address - Country:US
Mailing Address - Phone:404-345-5557
Mailing Address - Fax:281-310-8803
Practice Address - Street 1:1313 W. PARKWOOD, AVE
Practice Address - Street 2:STE. 101
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546
Practice Address - Country:US
Practice Address - Phone:281-947-8925
Practice Address - Fax:281-310-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty