Basic Information
| Provider Information | |||||||||
| NPI: | 1073282083 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKY SUITE THERAPY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4919 ORCHARD GARDEN WAY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770663437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325883280 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15211 PARK ROW | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325883280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2021 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | IRVIN | ||||||||
| AuthorizedOfficialFirstName: | RACHEAL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8325883280 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MA, LPC | ||||||||
| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.