=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447038468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAVILOUS ANALYSIS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2023
-----------------------------------------------------
Last Update Date | 09/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7960 US HIGHWAY 287 E
-----------------------------------------------------
City | CORRIGAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75939-9000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-209-0052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10
-----------------------------------------------------
City | WOODLAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75865-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-209-0052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SARAH E FAVILLA
-----------------------------------------------------
Credential | MA, BCBA, LBA
-----------------------------------------------------
Telephone | 717-209-0052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------