MEDICARE: GOLDEN STARS ABA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1033855150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN STARS ABA, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2269
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77497-2269
Country	:	US
Telephone Number	:	713-408-0672
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 WEST LOOP SOUTH
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027
Country	:	US
Telephone Number	:	713-408-0672
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	IDARA USORO
Credential	:
Telephone Number	:	713-408-0672

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/19/2022

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