MEDICARE: BEHAVIORAL PROGRESSIONS

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	305S00000X	Point of Service	1106824	TX

General Provider Information

NPI Number	:	1215281084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL PROGRESSIONS

Provider Business Mailing Address
First Line	:	6504 SHINER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-7520
Country	:	US
Telephone Number	:	325-374-9525
Fax Number	:

Provider Business Practice Location Address
First Line	:	6504 SHINER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-7520
Country	:	US
Telephone Number	:	325-374-9525
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WHITNEY CARPER
Credential	:	M.ED., BCBA
Telephone Number	:	325-374-9525

Provider Enumeration Date	:	11/01/2012
Last Update Date	:	11/01/2012

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