=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083952279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARPE DIEM BEHAVIORAL CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2013
-----------------------------------------------------
Last Update Date | 01/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3602 LAKES OF KATY LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77493-2485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-543-5695
-----------------------------------------------------
Fax | 281-934-2040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3602 LAKES OF KATY LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77493-2485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-543-5695
-----------------------------------------------------
Fax | 281-934-2040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BEHAVIOR ANALYST/ OWNER
-----------------------------------------------------
Name | TRICIA M HENDERSON
-----------------------------------------------------
Credential | M.S., BCBA
-----------------------------------------------------
Telephone | 281-543-5695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-10-6945
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------