Extravagant Hair Studio

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

1420593 Issued in TX

Legal business name

EXTRAVAGANT HAIR STUDIO

Practice address

12810 Mills Breeze Dr
Houston, TX 77070-1381

Phone

(216) 323-9969

NPI assigned

Sep 6, 2016

Organization subpart

No

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

Authorized official

Name

Ms. Bennetta Joyce Reynolds

Title

Hair Prosthesis Specialist

Phone

(216) 323-9969

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1473120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473120000000",
    "number": "1407303605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12810 MILLS BREEZE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770701381",
            "telephone_number": "216-323-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12810 MILLS BREEZE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770701381",
            "telephone_number": "216-323-9969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTRAVAGANT HAIR STUDIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-06",
        "last_updated": "2016-09-06",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "BENNETTA",
        "authorized_official_middle_name": "JOYCE",
        "authorized_official_title_or_position": "HAIR PROSTHESIS SPECIALIST",
        "authorized_official_telephone_number": "216-323-9969",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TX",
            "license": "1420593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Houston, TX
• Providers in Houston, TX by specialty
• Prosthetic/Orthotic Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.