Easter Seals North Texas, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

EASTER SEALS NORTH TEXAS, INC.

Practice address

4443 N Josey LN
100
Carrollton, TX 75010-4605

Phone

(972) 394-8900

Fax

(972) 394-6266

NPI assigned

Apr 25, 2006

Organization subpart

Yes

Parent organization

EASTER SEALS CENTRAL TEXAS INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carol Khoury

Title

Cfo

Phone

(212) 727-4270

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Easterseals Lonestar Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Outpatient physical therapy / speech pathology certification: CCN 676720

Legal name

EASTER SEALS NORTH TEXAS, INC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

May 29, 2014

Last certification

Jul 6, 2021

Ownership / control type

Voluntary Non-Profit Other Than Church

Facility address

4443 North Josey Lane Ste 100
Carrollton, TX 75010

Tax ID family

Easter Seals North Texas2 organizations share this tax ID, including this one

Part of

Easter Seals Central Texas Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Easter Seals North Texas, Inc.

  • Community/Behavioral Health Agency
  • Dallas, TX
  • NPI 1396702122
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristen Dodderer, MS, OTR/L

  • Occupational Therapist
  • Dallas, TX
  • NPI 1043549389
  NPD (past)
• Lauren Elizabeth Oberman, OTD, OTR

  • Occupational Therapist
  • Carrollton, TX
  • NPI 1598586463
  NPD (past)
• Laura Phillips, M.S. CCC-SLP

  • Speech-Language Pathologist
  • Carrollton, TX
  • NPI 1376223636
  NPD (past)
• Fabian Silva, MS, LBA, BCBA

  • Behavior Analyst
  • Flower Mound, TX
  • NPI 1376045914
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745539200000",
    "number": "1174589220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 3RD AVE FL 6",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100176733",
            "telephone_number": "817-542-1988",
            "fax_number": "817-303-9274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4443 N JOSEY LN",
            "address_2": "100",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104605",
            "telephone_number": "972-394-8900",
            "fax_number": "972-394-6266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTER SEALS NORTH TEXAS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTER SEALS CENTRAL TEXAS INC",
        "enumeration_date": "2006-04-25",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A",
        "authorized_official_last_name": "KHOURY",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "212-727-4270"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHSCN",
            "identifier": "1261315-07",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126131504",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Easterseals Lonestar",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jody Lee Ebert, MS LPC
• Shadi Edalati, MD
• Matthew Lee Edge, LPC-ASSOCIATE, MS

• Community/Behavioral Health Agency in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Community/Behavioral Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.