1366815862 NPI number — MR. ADAM SCOTT CLINE M.ED., BCBA

Table of content: MR. ADAM SCOTT CLINE M.ED., BCBA (NPI 1366815862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366815862 NPI number — MR. ADAM SCOTT CLINE M.ED., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLINE
Provider First Name:
ADAM
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., BCBA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366815862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3422 CHALLIS TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-4433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-898-0692
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6105 WINDCOM CT
Provider Second Line Business Practice Location Address:
STE. 400
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-7889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-312-8733
Provider Business Practice Location Address Fax Number:
972-378-4747
Provider Enumeration Date:
11/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-14-17714 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-14-17714 . This is a "BOARD CERTIFIED BEHAVIOR ANALYST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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