Extending Creative Minds

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EXTENDING CREATIVE MINDS

Practice address

10311 Homestead Rd
Houston, TX 77016-3305

Phone

(832) 506-8121

Fax

(832) 717-2781

NPI assigned

Apr 22, 2016

Organization subpart

No

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

Authorized official

Name

Lakisha R Dickerson

Title

Chief Executive Officer

Phone

(832) 506-8121

Specialties & licenses 5

Addresses

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

{
    "created_epoch": "1461283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496102400000",
    "number": "1417301763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10311 HOMESTEAD RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770163305",
            "telephone_number": "832-506-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10311 HOMESTEAD RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770163305",
            "telephone_number": "832-506-8121",
            "fax_number": "832-717-2781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDING CREATIVE MINDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-22",
        "last_updated": "2017-05-30",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "LAKISHA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "832-506-8121"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "57323",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "08693",
            "primary": false
        },
        {
            "code": "1835P1300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Psychiatric",
            "state": "TX",
            "license": "33415",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "K8989",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Extended Family Home Healthcare LLC
• Extended Family Inc
• Extended Home Health Inc
• Extended Laboratory Services, L.P.
• Extended Outreach Living LLC
• Extending Creative Minds
• Extra Care PHP
• Extra Mile Nonemergency Transport LLC
• Extraordinary Healthcare Services
• Extraordinary Home Health Care LLC

• Family Medicine Physician in Houston, TX
• Providers in Houston, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2017; 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.