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General NPI Number Information
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NPI Number | 1609356096
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Entity Type | Organization
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Legal Business Name | PUSH CONSULTANTS LLC
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 1305 ARKANSAS BLVD STE 104
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City | TEXARKANA
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State | AR
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Zip | 71854-1691
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Country | US
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Telephone | 970-330-9702
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Fax | 870-330-9646
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Provider Business Mailing Address
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Address Line | PO BOX 5395
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City | BOSSIER CITY
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State | LA
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Zip | 71171-5395
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Country | US
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Telephone | 318-918-0671
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Fax | 903-471-5133
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Authorized Official
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Title or Position | COO
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Name | KOTEKA SHANTAL JENKINS
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Credential |
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Telephone | 903-471-5132
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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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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | TX
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