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General NPI Number Information
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NPI Number | 1841011616
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Entity Type | Organization
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Legal Business Name | CHILDREN'S BEHAVIOR CLINIC, PLLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 1 CHISHOLM TRAIL RD STE 450
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City | ROUND ROCK
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State | TX
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Zip | 78681-5094
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Country | US
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Telephone | 956-545-9327
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Fax |
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Provider Business Mailing Address
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Address Line | 1051 KENNEY FORT XING UNIT 76
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City | ROUND ROCK
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State | TX
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Zip | 78665-2295
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Country | US
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Telephone | 956-545-9327
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | MARTHA ELI PACHECO
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Credential | BCBA, LBA
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Telephone | 956-545-9327
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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 |
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License Number State |
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