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General NPI Number Information
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NPI Number | 1952918682
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Entity Type | Organization
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Legal Business Name | BLUE ANGELS THERAPEDS, LLC
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Dates
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Enumeration Date | 09/27/2020
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Last Update Date | 09/27/2020
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Provider Practice Location Address
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Address Line | 1400 RIVERY BLVD APT 4116
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City | GEORGETOWN
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State | TX
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Zip | 78628-3041
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Country | US
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Telephone | 512-800-3097
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 RIVERY BLVD APT 4116
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City | GEORGETOWN
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State | TX
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Zip | 78628-3041
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Country | US
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Telephone | 512-800-3097
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AURICA GARZA
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Credential | BCBA
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Telephone | 512-800-3097
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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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