| Divergent Abilities | |
|
1503 Balsam Way Round Rock TX 78665-2389 | |
| (512) 550-7472 | |
| Not Available |
| Full Name | Divergent Abilities |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1503 Balsam Way, Round Rock, Texas |
| Authorized Official Name and Position | Stephanie Michelle Martinez (CO-FOUNDER/BEHAVIOR ANALYST) |
| Authorized Official Contact | 5125507472 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divergent Abilities 1503 Balsam Way Round Rock TX 78665-2389 Ph: (512) 550-7472 | Divergent Abilities 1503 Balsam Way Round Rock TX 78665-2389 Ph: (512) 550-7472 |
| NPI Number | 1912663998 |
|---|---|
| Provider Enumeration Date | 11/13/2021 |
| Last Update Date | 08/02/2024 |
| Certification Date | 08/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912663998 | NPI | - | NPPES |
| 4314395 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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