Healthcare Provider Details

I. General information

NPI: 1255003943
Provider Name (Legal Business Name): ACTION BEHAVIOR CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W 144TH AVE UNIT 100
BROOMFIELD CO
80023-9511
US

IV. Provider business mailing address

1601 S MOPAC EXPY SUITE C-300
AUSTIN TX
78746
US

V. Phone/Fax

Practice location:
  • Phone: 512-920-1239
  • Fax: 512-957-0699
Mailing address:
  • Phone: 512-920-1239
  • Fax: 512-957-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA L GOMEZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 512-551-1717