MEDICARE: BEHAVIOR SERVICES OF TEXAS, 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	:	1861158081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIOR SERVICES OF TEXAS, LLC

Provider Business Mailing Address
First Line	:	71 LONG HORN LOOP
Second Line	:
City	:	NEW WAVERLY
State	:	TX
Zip	:	77358-3734
Country	:	US
Telephone Number	:	719-209-1774
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 LONG HORN LOOP
Second Line	:
City	:	NEW WAVERLY
State	:	TX
Zip	:	77358-3734
Country	:	US
Telephone Number	:	719-209-1774
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHARMAYNE MARCHUK
Credential	:	BCBA
Telephone Number	:	719-209-1774

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	04/07/2026

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