Healthcare Provider Details

I. General information

NPI: 1255948147
Provider Name (Legal Business Name): GOLDEN STEPS ABA TX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17304 PRESTON RD STE 800
DALLAS TX
75252-5645
US

IV. Provider business mailing address

600 3RD AVE FL 2
NEW YORK NY
10016-1919
US

V. Phone/Fax

Practice location:
  • Phone: 615-570-9959
  • Fax:
Mailing address:
  • Phone: 646-873-6600
  • 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: REBECCA E ROSS
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 646-873-6600