1700411642 NPI number — BEHAVIORAL FOCUS

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 1700411642 NPI number — BEHAVIORAL FOCUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL FOCUS
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:
BEHAVIORAL FOCUS
Provider Other Organization Name Type Code:
3
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:
1700411642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 APPIAN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37174-6206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-818-5979
Provider Business Mailing Address Fax Number:
866-373-8243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
749 GATEWAY STE F-702
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79602-1196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-530-4089
Provider Business Practice Location Address Fax Number:
866-373-8243
Provider Enumeration Date:
03/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
TRUBE CASSANDRA MILL
Authorized Official Middle Name:
CASSANDRA
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
903-818-5979

Provider Taxonomy Codes

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

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

  • Identifier: 64745 . This is a "LICENSED PROFESSIONAL COUNSELOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1-17-26192 . This is a "BCBA NUMBER" identifier . This identifiers is of the category "OTHER".




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