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General NPI Number Information
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NPI Number | 1962182543
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Entity Type | Organization
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Legal Business Name | A GIFTED JOURNEY ( BEHAVIORAL, CONSULTING AND ADVOCACY)
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 833 BROCKDEN DR
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City | MESQUITE
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State | TX
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Zip | 75149-3275
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Country | US
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Telephone | 952-393-7755
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Fax |
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Provider Business Mailing Address
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Address Line | 833 BROCKDEN DR
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City | MESQUITE
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State | TX
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Zip | 75149-3275
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Country | US
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Telephone | 952-393-7755
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Fax |
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | JELISIA JEMAE THOMPSON
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Credential | BCBA, LBA
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Telephone | 952-393-7755
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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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