Provider Demographics
NPI:1770120719
Name:AMAZING & CREATIVE THERAPY ON THE SPECTRUM LLC
Entity type:Organization
Organization Name:AMAZING & CREATIVE THERAPY ON THE SPECTRUM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HYESHIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOUWHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-758-0090
Mailing Address - Street 1:1307 SHERWOOD POINT LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2857
Mailing Address - Country:US
Mailing Address - Phone:832-758-0090
Mailing Address - Fax:
Practice Address - Street 1:14058 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6848
Practice Address - Country:US
Practice Address - Phone:281-752-0403
Practice Address - Fax:281-752-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty