Healthcare Provider Details

I. General information

NPI: 1164108791
Provider Name (Legal Business Name): BOUNDLESS BEHAVIOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7342 BRIDGEVIEW DR
WESLEY CHAPEL FL
33545-9104
US

IV. Provider business mailing address

7342 BRIDGEVIEW DR
WESLEY CHAPEL FL
33545-9104
US

V. Phone/Fax

Practice location:
  • Phone: 815-514-0818
  • Fax:
Mailing address:
  • Phone: 815-514-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA M BOUDREAU
Title or Position: OWNER
Credential: MS
Phone: 815-514-0818