| Phoenix Rising Behavioral Services Llc | |
|
12638 Ridgeline Blvd Apt 6304 Cedar Park TX 78613-1212 | |
| (512) 761-6775 | |
| (737) 367-3007 |
| Full Name | Phoenix Rising Behavioral Services Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 12638 Ridgeline Blvd Apt 6304, Cedar Park, Texas |
| Authorized Official Name and Position | Stephanie Waldon (BOARD CERTIFIED BEHAVIOR ANALYST) |
| Authorized Official Contact | 5127616775 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Behavioral Services Llc 12638 Ridgeline Blvd Apt 6304 Cedar Park TX 78613-1212 Ph: (254) 677-5011 | Phoenix Rising Behavioral Services Llc 12638 Ridgeline Blvd Apt 6304 Cedar Park TX 78613-1212 Ph: (512) 761-6775 |
| NPI Number | 1114756475 |
|---|---|
| Provider Enumeration Date | 07/26/2024 |
| Last Update Date | 08/09/2024 |
| Certification Date | 08/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114756475 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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