Healthcare Provider Details

I. General information

NPI: 1114496353
Provider Name (Legal Business Name): HEART OF BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 10/14/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6399 FISHTRAP RD
DENTON TX
76208-1607
US

IV. Provider business mailing address

2101 COLORADO BLVD UNIT 52115
DENTON TX
76206-2887
US

V. Phone/Fax

Practice location:
  • Phone: 214-608-7120
  • Fax: 940-243-8195
Mailing address:
  • Phone: 214-608-7120
  • Fax: 940-243-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TASHENNA GILLMORE
Title or Position: OWNER/BCBA
Credential: M.ED, BCBA
Phone: 214-608-7120