Healthcare Provider Details

I. General information

NPI: 1679105522
Provider Name (Legal Business Name): WHOLE HEALTH BEHAVIOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2020
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W LINDBERGH BLVD
UNIVERSAL CITY TX
78148-4322
US

IV. Provider business mailing address

122 W LINDBERGH BLVD
UNIVERSAL CITY TX
78148-4322
US

V. Phone/Fax

Practice location:
  • Phone: 210-701-0525
  • Fax:
Mailing address:
  • Phone: 210-701-0525
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: LAURA LEE MCWHORTER
Title or Position: OWNER
Credential: LBA, BCBA
Phone: 210-844-5710