Healthcare Provider Details

I. General information

NPI: 1437969987
Provider Name (Legal Business Name): TETACHILD BEHAVIOR CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PAT BOOKER RD STE 207
UNIVERSAL CITY TX
78148-4148
US

IV. Provider business mailing address

9303 AVONDALE PARK
CONVERSE TX
78109-0357
US

V. Phone/Fax

Practice location:
  • Phone: 210-903-0130
  • Fax: 800-383-9015
Mailing address:
  • Phone: 917-783-8065
  • Fax: 800-383-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TEMORA P GRAY
Title or Position: OWNER
Credential: PHD, BCBA
Phone: 210-903-0130