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NPI Code Detail

MEDICARE: EDL LLC

MEDICARE: EDL 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1184284226
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDL LLC
Provider Business Mailing Address
First Line : 14516 OLIVE HILL DR
Second Line :
City : AUSTIN
State : TX
Zip : 78717-4589
Country : US
Telephone Number : 512-739-8476
Fax Number :
Provider Business Practice Location Address
First Line : 2105 E PARK ST
Second Line :
City : CEDAR PARK
State : TX
Zip : 78613-4598
Country : US
Telephone Number : 512-739-8476
Fax Number :
Authorized Official
Title or Position : MANAGING DIRECTOR
Name : AN PHAM
Credential :
Telephone Number : 512-739-8476
Provider Enumeration Date : 06/20/2019
Last Update Date : 06/20/2019

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Directions to “EDL LLC ” Practice Location

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