1922516038 NPI number — AIMEE TANOS LPC PLLC

Table of content: (NPI 1922516038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922516038 NPI number — AIMEE TANOS LPC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIMEE TANOS LPC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
A HOLDING SPACE FOR HEALING AND GROWTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922516038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7808 ILESON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBREY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76227-4477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 N LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76201-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-602-3623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
TANOS
Authorized Official First Name:
AIMEE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
817-602-3623

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  62538 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1295061521 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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