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NPI Code Detail

MEDICARE: BLUE SPRIG AUTISM

MEDICARE: BLUE SPRIG AUTISM
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1538095294
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE SPRIG AUTISM
Provider Business Mailing Address
First Line : 2317 BRENDA LN
Second Line :
City : KELLER
State : TX
Zip : 76262-6827
Country : US
Telephone Number : 814-681-4370
Fax Number :
Provider Business Practice Location Address
First Line : 1652 KELLER PKWY STE 200
Second Line :
City : KELLER
State : TX
Zip : 76248-3877
Country : US
Telephone Number : 682-291-9910
Fax Number :
Authorized Official
Title or Position : BT
Name : LAUREL REYNOLDS
Credential :
Telephone Number : 814-681-4370
Provider Enumeration Date : 06/22/2026
Last Update Date : 06/22/2026

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Directions to “BLUE SPRIG AUTISM ” Practice Location

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