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General NPI Number Information
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NPI Number | 1124836978
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Entity Type | Organization
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Legal Business Name | DIVINITY ABA, LLC.
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1508 EMERALD KNOLL DRIVE
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City | KELLER
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State | TX
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Zip | 76248-1506
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Country | US
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Telephone | 817-455-5920
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 EMERALD KNOLL DRIVE
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City | KELLER
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State | TX
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Zip | 76248-1506
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Country | US
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Telephone | 817-455-5920
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | MRS. BETH A WORMAN
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Credential |
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Telephone | 817-455-5920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 225XM0800X
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Taxonomy Name | Mental Health Occupational 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 | 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 #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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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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