Healthcare Provider Details

I. General information

NPI: 1861239964
Provider Name (Legal Business Name): ACTION BEHAVIOR CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 TOWER RD STE C-2
DENVER CO
80249-7381
US

IV. Provider business mailing address

1601 S MOPAC EXPY STE C300
AUSTIN TX
78746-7077
US

V. Phone/Fax

Practice location:
  • Phone: 720-440-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
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