Healthcare Provider Details

I. General information

NPI: 1609356096
Provider Name (Legal Business Name): PUSH CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 ARKANSAS BLVD STE 104
TEXARKANA AR
71854-1691
US

IV. Provider business mailing address

PO BOX 5395
BOSSIER CITY LA
71171-5395
US

V. Phone/Fax

Practice location:
  • Phone: 970-330-9702
  • Fax: 870-330-9646
Mailing address:
  • Phone: 318-918-0671
  • Fax: 903-471-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KOTEKA SHANTAL JENKINS
Title or Position: COO
Credential:
Phone: 903-471-5132