Provider Demographics
NPI:1043626369
Name:ASSESSMENT BEHAVIOR ANALYSIS AND COUNSELING SERVICES
Entity type:Organization
Organization Name:ASSESSMENT BEHAVIOR ANALYSIS AND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANDELA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC BCBA
Authorized Official - Phone:940-631-0239
Mailing Address - Street 1:2738 SHEPHERDS GLN
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-5264
Mailing Address - Country:US
Mailing Address - Phone:940-631-0239
Mailing Address - Fax:
Practice Address - Street 1:2401 KEMP BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-5348
Practice Address - Country:US
Practice Address - Phone:940-631-0239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty