Healthcare Provider Details

I. General information

NPI: 1578240206
Provider Name (Legal Business Name): GREAT STRIDES BEHAVIOR ANALYST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 CHATEAU CREEK WAY
SPRING TX
77386-3509
US

IV. Provider business mailing address

4411 CHATEAU CREEK WAY
SPRING TX
77386-3509
US

V. Phone/Fax

Practice location:
  • Phone: 845-596-2271
  • Fax:
Mailing address:
  • Phone:
  • 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 Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: YOCHEVED WASSERMAN
Title or Position: PRESIDENT
Credential:
Phone: 845-596-2271