=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275219057
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY ABA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2023
-----------------------------------------------------
Last Update Date | 06/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5200 SADDLE DR
-----------------------------------------------------
City | FLOWER MOUNT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-400-1983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 SADDLE DR
-----------------------------------------------------
City | FLOWER MOUNT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-400-1983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STACI CODDINGTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-400-1983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------