MEDICARE: BEHAVIOR SUPPORT 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	:	1093197436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIOR SUPPORT SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	518 SAINT CHARLES ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-4036
Country	:	US
Telephone Number	:	713-299-9082
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 SAINT CHARLES ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-4036
Country	:	US
Telephone Number	:	713-299-9082
Fax Number	:

Authorized Official
Title or Position	:	OWNER/BEHAVIOR ANALYST
Name	:	KARILYN ROTE
Credential	:	BCBA
Telephone Number	:	713-299-9082

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/22/2015

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