=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639053622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISE WITH ABA ROCKET, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2025
-----------------------------------------------------
Last Update Date | 08/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17840 MOUND RD STE A
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433-4821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-369-7207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5507 CHERRY CREEK BEND CT
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77041-6410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-369-7207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANTHONY SHIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 571-369-7207
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------