1073828562 NPI number — THERAPEUTIC SOLUTIONS 101

Table of content: (NPI 1073828562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073828562 NPI number — THERAPEUTIC SOLUTIONS 101

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC SOLUTIONS 101
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:
Provider Other Organization Name Type Code:
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:
1073828562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2211 ACORN GLEN TRL
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77545-6084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-972-9365
Provider Business Mailing Address Fax Number:
281-710-4196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 ACORN GLEN TRL
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77545-6084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-972-9365
Provider Business Practice Location Address Fax Number:
281-710-4196
Provider Enumeration Date:
08/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON-BATISTE
Authorized Official First Name:
BRANDYE
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST/CEO
Authorized Official Telephone Number:
281-972-9365

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  103688 , 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: 1619124518 . This is a "TYPE 1 NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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