Basic Information
| Provider Information | |||||||||
| NPI: | 1487699344 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARRIS COUNTY DEPARTMENT OF EDUCATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11920 WALTERS RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770671956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813974015 | ||||||||
| FaxNumber: | 2813974003 | ||||||||
| Practice Location | |||||||||
| Address1: | 11920 WALTERS ROAD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770671957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136963131 | ||||||||
| FaxNumber: | 7136962133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 10/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | AMEZCUA | ||||||||
| AuthorizedOfficialFirstName: | JESUS | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASST. SUPERINTENDENT, BUS. SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 7136961371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 101Y00000X | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 104100000X | 104100000X | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 133VN1004X | 133VN1004X | TX | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric | 163W00000X | 163W00000X | TX | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 224Z00000X | 224Z00000X | TX | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 225100000X | 225100000X | TX | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 225X00000X | TX | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | 235Z00000X | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 155194701 | 05 | TX | MEDICAID |