1598588659 NPI number — BEHAVIORAL EDUCATION AND AWARENESS PROGRAMS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598588659 NPI number — BEHAVIORAL EDUCATION AND AWARENESS PROGRAMS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL EDUCATION AND AWARENESS PROGRAMS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1598588659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 BALCONES DR STE 17177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-4257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-708-6672
Provider Business Mailing Address Fax Number:
469-209-1395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 LITTLE JOHN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-5911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-708-6672
Provider Business Practice Location Address Fax Number:
469-209-1395
Provider Enumeration Date:
11/06/2024

Additional Information

Authorized Official

Authorized Official Last Name:
FUENTES MAY
Authorized Official First Name:
DESIRE
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official Telephone Number:
469-708-6672

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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