Provider Demographics
NPI:1548710353
Name:EASTER SEALS CENTRAL TEXAS INC
Entity type:Organization
Organization Name:EASTER SEALS CENTRAL TEXAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-615-6809
Mailing Address - Street 1:8505 CROSS PARK DR
Mailing Address - Street 2:STE 120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-4577
Mailing Address - Country:US
Mailing Address - Phone:512-615-6809
Mailing Address - Fax:512-615-7121
Practice Address - Street 1:8505 CROSS PARK DR
Practice Address - Street 2:STE 120
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-4577
Practice Address - Country:US
Practice Address - Phone:512-615-6809
Practice Address - Fax:512-615-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty