MEDICARE: WONDER BEHAVIOR CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1114895588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONDER BEHAVIOR CENTERS LLC

Provider Business Mailing Address
First Line	:	1801 WITTINGTON PL STE 280
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-1993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 WITTINGTON PL STE 280
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-1993
Country	:	US
Telephone Number	:	617-675-0638
Fax Number	:	508-519-9188

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	DEE VISCOUNT
Credential	:
Telephone Number	:	617-675-0638

Provider Enumeration Date	:	10/28/2025
Last Update Date	:	10/28/2025

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