Provider Demographics
NPI:1720444524
Name:THERAPY LEARNING CENTER, EAST TEXAS CLINIC
Entity Type:Organization
Organization Name:THERAPY LEARNING CENTER, EAST TEXAS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:214-675-4685
Mailing Address - Street 1:910 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-5865
Mailing Address - Country:US
Mailing Address - Phone:214-675-4685
Mailing Address - Fax:
Practice Address - Street 1:910 HOLLY HILL LN
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5865
Practice Address - Country:US
Practice Address - Phone:214-675-4685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112571261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3470676Medicaid