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General NPI Number Information
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NPI Number | 1437969987
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Entity Type | Organization
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Legal Business Name | TETACHILD BEHAVIOR CONSULTANTS, LLC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1001 PAT BOOKER RD STE 207
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-4148
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Country | US
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Telephone | 210-903-0130
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Fax | 800-383-9015
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Provider Business Mailing Address
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Address Line | 9303 AVONDALE PARK
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City | CONVERSE
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State | TX
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Zip | 78109-0357
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Country | US
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Telephone | 917-783-8065
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Fax | 800-383-9015
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Authorized Official
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Title or Position | OWNER
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Name | TEMORA P GRAY
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Credential | PHD, BCBA
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Telephone | 210-903-0130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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