Provider Demographics
NPI:1528420171
Name:WAYMAKER TX, LLC
Entity type:Organization
Organization Name:WAYMAKER TX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL TREATMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:TOUSANT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-692-2179
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-0743
Mailing Address - Country:US
Mailing Address - Phone:281-692-2179
Mailing Address - Fax:832-201-7898
Practice Address - Street 1:608 BRIARWILDE CT
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-3623
Practice Address - Country:US
Practice Address - Phone:281-692-2179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty