Healthcare Provider Details

I. General information

NPI: 1487574190
Provider Name (Legal Business Name): BLUEBONNET BEHAVIORAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 JOE DIMAGGIO BLVD STE 21
ROUND ROCK TX
78665-3933
US

IV. Provider business mailing address

2851 JOE DIMAGGIO BLVD STE 21
ROUND ROCK TX
78665-3933
US

V. Phone/Fax

Practice location:
  • Phone: 512-900-6268
  • Fax: 512-900-6269
Mailing address:
  • Phone: 512-900-6268
  • Fax: 512-900-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MARLYN ORTEGA
Title or Position: OWNER
Credential:
Phone: 786-535-0453