Provider Demographics
NPI:1952620445
Name:MILESTONES DEVELOPMENTAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:MILESTONES DEVELOPMENTAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHABILITATION
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:713-533-9826
Mailing Address - Street 1:5445 ALMEDA RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7434
Mailing Address - Country:US
Mailing Address - Phone:713-533-9826
Mailing Address - Fax:713-533-9828
Practice Address - Street 1:5445 ALMEDA RD
Practice Address - Street 2:SUITE 222
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7434
Practice Address - Country:US
Practice Address - Phone:713-533-9826
Practice Address - Fax:713-533-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204604701Medicaid