MEDICARE: ABSOLUTE BEHAVIOR ADVANCEMENT

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	:	1972125672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE BEHAVIOR ADVANCEMENT

Provider Business Mailing Address
First Line	:	23018 SANDPIPER TRL
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-5405
Country	:	US
Telephone Number	:	803-257-4637
Fax Number	:

Provider Business Practice Location Address
First Line	:	23018 SANDPIPER TRL
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-5405
Country	:	US
Telephone Number	:	803-257-4637
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	MISS LADELRIE SHANIKA HALL
Credential	:	BCBA. LBA
Telephone Number	:	803-257-4637

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	05/15/2020

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Directions to “ABSOLUTE BEHAVIOR ADVANCEMENT ” Practice Location

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