MEDICARE: ACTION BEHAVIOR CENTERS THERAPY 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1083560668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTION BEHAVIOR CENTERS THERAPY LLC

Provider Business Mailing Address
First Line	:	6300 BEE CAVES RD BLDG 2-100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-5842
Country	:	US
Telephone Number	:	512-615-5186
Fax Number	:

Provider Business Practice Location Address
First Line	:	9516 FEDERAL DRIVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-4319
Country	:	US
Telephone Number	:	719-888-5523
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SAMANTHA L GOMEZ
Credential	:
Telephone Number	:	512-508-3941

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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