Provider Demographics
NPI:1841959806
Name:EAST TEXAS EATING DISORDER SPECIALISTS
Entity type:Organization
Organization Name:EAST TEXAS EATING DISORDER SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CEDS
Authorized Official - Phone:903-287-0780
Mailing Address - Street 1:100 INDEPENDENCE PL STE 212
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1327
Mailing Address - Country:US
Mailing Address - Phone:903-287-0780
Mailing Address - Fax:903-561-8799
Practice Address - Street 1:100 INDEPENDENCE PL STE 212
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1327
Practice Address - Country:US
Practice Address - Phone:903-287-0780
Practice Address - Fax:903-561-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)