Healthcare Provider Details

I. General information

NPI: 1134075708
Provider Name (Legal Business Name): ACTION BEHAVIOR CENTERS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9516 FEDERAL DRIVE
COLORADO SPRINGS CO
80921-4319
US

IV. Provider business mailing address

6300 BEE CAVES RD BLDG 2-100
AUSTIN TX
78746-5842
US

V. Phone/Fax

Practice location:
  • Phone: 719-888-5523
  • Fax:
Mailing address:
  • Phone: 512-615-5186
  • Fax:

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: 512-508-3941