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General NPI Number Information
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NPI Number | 1003452574
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Entity Type | Organization
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Legal Business Name | PROVIDENCE BEHAVIOR THERAPY
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 119 CIMARRON PARK LOOP STE A
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City | BUDA
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State | TX
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Zip | 78610-2839
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Country | US
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Telephone | 970-219-7735
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Fax |
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Provider Business Mailing Address
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Address Line | 4131 SPICEWOOD SPRINGS RD UNIT K2
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City | AUSTIN
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State | TX
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Zip | 78759
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Country | US
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Telephone | 512-200-2792
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Fax | 877-331-1021
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER SKEEN
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Credential | BCBA, LBA
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Telephone | 512-200-2792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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