=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265889745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME FOCUS ABA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2016
-----------------------------------------------------
Last Update Date | 05/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6804 CAPITAL OF TX HWY N 412
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-298-5567
-----------------------------------------------------
Fax | 512-394-3222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6804 CAPITAL OF TX HWY N 412
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-298-5567
-----------------------------------------------------
Fax | 512-394-3222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO FOUNDER
-----------------------------------------------------
Name | JESSICA LYNN GRAVEL
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 512-298-5567
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-15-19365
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-14-16451
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------