Organization
THE SHAPE OF BEHAVIOR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMONIQUE RANDALL PHD (CEO)
(832) 358-2655
Entity
Organization
Contact information
Practice address
12941 NORTH FWY, STE 750, HOUSTON, TX 77060-1240
(832) 358-2655
(832) 358-3530
Mailing address
12941 NORTH FWY, STE 750, HOUSTON, TX 77060-1240
(832) 358-2655
(832) 358-3530
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
08/24/2015
Last updated
08/24/2015
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