Provider Demographics
NPI:1871095323
Name:TEXAS BEHAVIOR SERVICES, LLC
Entity type:Organization
Organization Name:TEXAS BEHAVIOR SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:940-536-3211
Mailing Address - Street 1:1619 DREAM CATCHER WAY
Mailing Address - Street 2:
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-5885
Mailing Address - Country:US
Mailing Address - Phone:940-536-3211
Mailing Address - Fax:
Practice Address - Street 1:1619 DREAM CATCHER WAY
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249-5885
Practice Address - Country:US
Practice Address - Phone:940-536-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-09-5043103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty