MEDICARE: BEAUTIFUL MINDS ABA PLLC

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

General Provider Information

NPI Number	:	1134825623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL MINDS ABA PLLC

Provider Business Mailing Address
First Line	:	2701 ALESSANDRIA LN
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2289
Country	:	US
Telephone Number	:	949-294-6802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 ALESSANDRIA LN
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2289
Country	:	US
Telephone Number	:	949-294-6802
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	DR. MAYRA CORONA-MORENO
Credential	:
Telephone Number	:	949-294-6802

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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