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1636 W Irving Blvd Ste 100 Irving TX 75061-7255 | |
| (469) 575-9294 | |
| (469) 895-2200 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1636 W Irving Blvd Ste 100, Irving, Texas |
| Authorized Official Name and Position | Wonji Chu (ADMINISTRATOR) |
| Authorized Official Contact | 4696880285 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1636 W Irving Blvd Ste 100 Irving TX 75061-7255 Ph: (469) 565-2454 | 1636 W Irving Blvd Ste 100 Irving TX 75061-7255 Ph: (469) 575-9294 |
| NPI Number | 1588337117 |
|---|---|
| Provider Enumeration Date | 07/29/2021 |
| Last Update Date | 09/04/2023 |
| Certification Date | 09/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588337117 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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