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NPI Code Detail

MEDICARE: STORMY LEE JUDGE

MEDICARE: STORMY LEE JUDGE
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 Analyst1-24-77928TX

General Provider Information

NPI Number : 1255927745
Entity Type Code : Individual
Provider Name (Legal Business Name) : STORMY LEE JUDGE
Provider Business Mailing Address
First Line : 189 N PLANO RD STE 100
Second Line :
City : RICHARDSON
State : TX
Zip : 75081-8001
Country : US
Telephone Number : 469-828-8252
Fax Number :
Provider Business Practice Location Address
First Line : 189 N PLANO RD STE 100
Second Line :
City : RICHARDSON
State : TX
Zip : 75081-8001
Country : US
Telephone Number : 469-828-8252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2020
Last Update Date : 02/27/2025

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Directions to “ STORMY LEE JUDGE ” Practice Location

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