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General NPI Number Information
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NPI Number | 1861192726
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Entity Type | Organization
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Legal Business Name | BLUEBONNET BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 8708 S CONGRESS AVE STE E500-109
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City | AUSTIN
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State | TX
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Zip | 78745-7379
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Country | US
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Telephone | 512-503-4801
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Fax |
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Provider Business Mailing Address
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Address Line | 8708 S CONGRESS AVE STE E500-109
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City | AUSTIN
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State | TX
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Zip | 78745-7379
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Country | US
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Telephone | 512-503-4801
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Fax |
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Authorized Official
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Title or Position | FOUNDER, CLINICAL DIRECTOR
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Name | VERONICA LARA
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Credential | BCBA, LBA
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Telephone | 512-503-4801
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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 |
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License Number State |
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