Provider Demographics
NPI:1104584564
Name:PROSOCIAL PEERS SOCIAL SKILLS
Entity type:Organization
Organization Name:PROSOCIAL PEERS SOCIAL SKILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REDUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-790-6779
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-0331
Mailing Address - Country:US
Mailing Address - Phone:832-790-6779
Mailing Address - Fax:
Practice Address - Street 1:21623 SAN MARINO DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7604
Practice Address - Country:US
Practice Address - Phone:832-790-6779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management