Healthcare Provider Details

I. General information

NPI: 1548719628
Provider Name (Legal Business Name): EMPOWER ABA THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S A W GRIMES BLVD
ROUND ROCK TX
78664-7429
US

IV. Provider business mailing address

11316 WET SEASON DR
AUSTIN TX
78754-5855
US

V. Phone/Fax

Practice location:
  • Phone: 512-817-6273
  • Fax: 512-367-5743
Mailing address:
  • Phone: 512-817-6273
  • Fax: 512-367-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ARUN PALANISWAMY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 512-817-6273