Provider Demographics
NPI:1578360954
Name:BEHAVIOR BRIDGES LLC
Entity type:Organization
Organization Name:BEHAVIOR BRIDGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEILA
Authorized Official - Middle Name:JASMIN
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:956-844-4056
Mailing Address - Street 1:507 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-5302
Mailing Address - Country:US
Mailing Address - Phone:956-844-4056
Mailing Address - Fax:956-849-7455
Practice Address - Street 1:1404 N GRANT ST STE 2
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5412
Practice Address - Country:US
Practice Address - Phone:956-844-4056
Practice Address - Fax:956-849-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty