Basic Information
| Provider Information | |||||||||
| NPI: | 1497912935 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN BEHAVIOR CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 420397 | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788420397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307755100 | ||||||||
| FaxNumber: | 8307755188 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 FLETCHER DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788403083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307755100 | ||||||||
| FaxNumber: | 8307755188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | KHOURY | ||||||||
| AuthorizedOfficialFirstName: | SHADIA | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED PROFESSIONAL COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 8307755100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.ED., LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 62156 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.