MEDICARE: AFFIRMATIVE PARENTING SOLUTIONS, LLC

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

General Provider Information

NPI Number	:	1083202527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFIRMATIVE PARENTING SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	108 W RUSSELL ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5360
Country	:	US
Telephone Number	:	817-549-5073
Fax Number	:	817-549-5062

Provider Business Practice Location Address
First Line	:	108 W RUSSELL ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5360
Country	:	US
Telephone Number	:	817-694-5073
Fax Number	:	817-549-5062

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	TREICHAE JANAE HOLMES
Credential	:	BCBA
Telephone Number	:	817-649-5073

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	09/14/2023

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