=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972188274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBBIE PHAM HUYNH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2021
-----------------------------------------------------
Last Update Date | 12/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9811 S INTERSTATE 35 STE 100
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78744-7901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-308-3728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 W ROOSEVELT RD STE 103
-----------------------------------------------------
City | WEST CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60185-4819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-308-3728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------