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General NPI Number Information
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NPI Number | 1194472787
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Entity Type | Organization
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Legal Business Name | PHOENIX ABA SERVICES
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Dates
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Enumeration Date | 03/03/2022
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Last Update Date | 03/29/2025
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Provider Practice Location Address
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Address Line | 1540 KELLER PKWY STE 108136
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City | KELLER
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State | TX
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Zip | 76248-3686
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Country | US
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Telephone | 682-593-3182
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Fax | 817-438-1426
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Provider Business Mailing Address
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Address Line | 3920 DREXMORE RD
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City | FORT WORTH
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State | TX
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Zip | 76244-8510
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Country | US
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Telephone | 817-948-9367
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIAH LAND
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Credential | BCBA
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Telephone | 817-948-9367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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