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General NPI Number Information
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NPI Number | 1770475337
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Entity Type | Individual
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Provider Name | STEPHON PRIMOUS
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Gender | Male
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 950 E STATE HIGHWAY 114 STE 160
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City | SOUTHLAKE
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State | TX
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Zip | 76092-5261
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Country | US
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Telephone | 949-401-3931
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Fax | 888-403-6922
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Provider Business Mailing Address
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Address Line | 5351 THUNDER CREEK RD
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City | AUSTIN
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State | TX
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Zip | 78759-4021
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Country | US
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Telephone | 949-401-3931
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Fax | 888-403-6922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1-25-80451
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License Number State | TX
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