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General NPI Number Information
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NPI Number | 1730516295
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Entity Type | Organization
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Legal Business Name | BAUCOM BEHAVIORAL & EDUCATIONAL SERVICES
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 700 LAVACA ST STE 1401
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City | AUSTIN
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State | TX
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Zip | 78701-3101
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Country | US
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Telephone | 512-537-3014
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26642
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City | AUSTIN
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State | TX
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Zip | 78755-0642
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Country | US
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Telephone | 512-537-3014
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ALISON LORRAINE BAUCOM
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Credential | M.ED., BCBA
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Telephone | 512-537-3014
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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 | 1-12-12198
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License Number State | TX
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