Provider Demographics
NPI:1528777893
Name:BEAUTY OF IMPERFECTION, PLLC
Entity type:Organization
Organization Name:BEAUTY OF IMPERFECTION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-900-6243
Mailing Address - Street 1:4502 RIVERSTONE BLVD STE 702
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5210
Mailing Address - Country:US
Mailing Address - Phone:281-900-6243
Mailing Address - Fax:
Practice Address - Street 1:4502 RIVERSTONE BLVD STE 702
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5210
Practice Address - Country:US
Practice Address - Phone:281-900-6243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77752OtherLPC LICENSE