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General NPI Number Information
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NPI Number | 1063788289
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Entity Type | Organization
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Legal Business Name | TERESA BALAWEJDER
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 16304 COUNTY ROAD 2040
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City | LUBBOCK
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State | TX
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Zip | 79423-4618
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Country | US
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Telephone | 215-327-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 16304 COUNTY ROAD 2040
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City | LUBBOCK
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State | TX
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Zip | 79423-4618
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | TERESA BALAWEJDER
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Credential | BCBA
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Telephone | 215-327-4174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-08-4251
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License Number State | FL
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