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General NPI Number Information
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NPI Number | 1164108791
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Entity Type | Organization
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Legal Business Name | BOUNDLESS BEHAVIOR THERAPY LLC
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 7342 BRIDGEVIEW DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33545-9104
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Country | US
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Telephone | 815-514-0818
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Fax |
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Provider Business Mailing Address
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Address Line | 7342 BRIDGEVIEW DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33545-9104
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Country | US
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Telephone | 815-514-0818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. REBECCA M BOUDREAU
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Credential | MS
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Telephone | 815-514-0818
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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 | 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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