Healthcare Provider Details

I. General information

NPI: 1114890498
Provider Name (Legal Business Name): ACTION BEHAVIOR CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16830 NORTHGATE DR UNIT 150
PARKER CO
80134-5778
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 720-259-5505
  • Fax:
Mailing address:
  • Phone: 512-774-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA L GOMEZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 512-508-3941