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General NPI Number Information
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NPI Number | 1659794345
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Entity Type | Organization
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Legal Business Name | A-MAZE AUTISM AND BEHAVIOR SUPPORT LLC
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 1935 MAXWELL DR
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City | LEWISVILLE
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State | TX
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Zip | 75077-7577
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Country | US
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Telephone | 469-585-8184
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Fax |
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Provider Business Mailing Address
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Address Line | 1935 MAXWELL DR
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City | LEWISVILLE
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State | TX
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Zip | 75077-7577
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Country | US
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Telephone | 469-585-8184
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH HOUCK
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Credential | M.ED. BCBA
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Telephone | 469-585-8184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-09-6597
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1-09-6597
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-09-6597
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License Number State |
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