=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891150884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADIGM BEHAVIOR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2015
-----------------------------------------------------
Last Update Date | 12/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16103 PEACH BLUFF LN
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-5707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-677-2990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16103 PEACH BLUFF LN
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-5707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-677-2990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CHRISTINA TRAN CONNER
-----------------------------------------------------
Credential | M.ED., BCBA
-----------------------------------------------------
Telephone | 832-677-2990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 11212290
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------