Provider Demographics
NPI:1437969987
Name:TETACHILD BEHAVIOR CONSULTANTS, LLC
Entity type:Organization
Organization Name:TETACHILD BEHAVIOR CONSULTANTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEMORA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:210-903-0130
Mailing Address - Street 1:9303 AVONDALE PARK
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0357
Mailing Address - Country:US
Mailing Address - Phone:917-783-8065
Mailing Address - Fax:800-383-9015
Practice Address - Street 1:1001 PAT BOOKER RD STE 207
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-4148
Practice Address - Country:US
Practice Address - Phone:210-903-0130
Practice Address - Fax:800-383-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1437699987OtherCLINICAL PSYCHOLOGY