MEDICARE: ACTION POTENTIAL ABA

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1154192797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTION POTENTIAL ABA

Provider Business Mailing Address
First Line	:	2023 PLAINS CT
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-8863
Country	:	US
Telephone Number	:	469-463-5207
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 STATE HIGHWAY 161 STE 148
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2803
Country	:	US
Telephone Number	:	469-943-2500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. HALA ALZINATI-WISE
Credential	:
Telephone Number	:	469-463-5207

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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Directions to “ACTION POTENTIAL ABA ” Practice Location

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