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General NPI Number Information
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NPI Number | 1578360954
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Entity Type | Organization
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Legal Business Name | BEHAVIOR BRIDGES LLC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 1404 N GRANT ST STE 2
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City | ROMA
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State | TX
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Zip | 78584-5412
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Country | US
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Telephone | 956-844-4056
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Fax | 956-849-7455
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Provider Business Mailing Address
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Address Line | 507 N GRANT ST
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City | ROMA
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State | TX
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Zip | 78584-5302
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Country | US
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Telephone | 956-844-4056
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Fax | 956-849-7455
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. KEILA JASMIN PENA
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Credential | BCBA
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Telephone | 956-844-4056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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