Healthcare Provider Details

I. General information

NPI: 1376240580
Provider Name (Legal Business Name): ACTION BEHAVIOR CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19284 COTTONWOOD DRIVE STE 101
PARKER CO
80138-3881
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 720-457-3100
  • Fax:
Mailing address:
  • Phone: 512-920-1030
  • 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: 512-551-1717