=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083560668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACTION BEHAVIOR CENTERS THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2026
-----------------------------------------------------
Last Update Date | 03/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9516 FEDERAL DRIVE
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80921-4319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-888-5523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6300 BEE CAVES RD BLDG 2-100
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78746-5842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-615-5186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | SAMANTHA L GOMEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-508-3941
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------