{
"Npi": {
"NPI": "1730770884",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHILDREN'S BEHAVIORAL THERAPY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6305 HIGHPOINT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEAUMONT",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77708-3651",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "915-799-8722",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "710 S 8TH ST STE B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BEAUMONT",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77701-4634",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "409-299-9460",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/01/2021",
"LastUpdateDate": "07/25/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COSTA",
"AuthorizedOfficialFirstName": "CYNTHIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BEHAVIOR ANALYST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BCBA",
"AuthorizedOfficialTelephoneNumber": "915-799-8722",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QD1600X",
"TaxonomyName": "Developmental Disabilities Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103K00000X",
"TaxonomyName": "Behavior Analyst",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}