MEDICARE: BRIDGING BEHAVIORS

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	103K00000X	Behavior Analyst	1-14-16062	TX

General Provider Information

NPI Number	:	1083013296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGING BEHAVIORS

Provider Business Mailing Address
First Line	:	2427 FACET OAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2652
Country	:	US
Telephone Number	:	210-314-1545
Fax Number	:	210-314-1545

Provider Business Practice Location Address
First Line	:	2427 FACET OAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2652
Country	:	US
Telephone Number	:	210-314-1545
Fax Number	:	210-314-1545

Authorized Official
Title or Position	:	CO-OWNER
Name	:	BEVERLY SMITH
Credential	:
Telephone Number	:	210-314-1545

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	08/14/2014

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Directions to “BRIDGING BEHAVIORS ” Practice Location

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