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Active
Organization subpart
No

Provider details

NPI number
Authorized official
JESSICA LYNN GRAVEL BCBA (CO FOUNDER)
(512) 298-5567
Entity
Organization

Contact information

Practice address
6804 CAPITAL OF TX HWY N 412, AUSTIN, TX 78731
(512) 298-5567
(512) 394-3222
Mailing address
6804 CAPITAL OF TX HWY N 412, AUSTIN, TX 78731
(512) 298-5567
(512) 394-3222

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-16451
TX
103K00000X
Behavior Analyst
1-15-19365
TX

Other

Enumeration date
05/16/2016
Last updated
05/16/2016
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