=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902181191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLIED EDUCATIONAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2011
-----------------------------------------------------
Last Update Date | 10/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23913 PEDERNALES CANYON TRL
-----------------------------------------------------
City | SPICEWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78669-6498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-264-9206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23913 PEDERNALES CANYON TRL
-----------------------------------------------------
City | SPICEWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78669-6498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-264-9206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BEHAVIOR ANALYST
-----------------------------------------------------
Name | MRS. KINDRA DANIELLE COLEMAN-BOULWARE
-----------------------------------------------------
Credential | M.ED, BCBA
-----------------------------------------------------
Telephone | 512-217-5913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 1-11-8453
-----------------------------------------------------
License Number State |
-----------------------------------------------------