Provider Demographics
NPI:1740171636
Name:DEEP BLUE BEHAVIOR THERAPY
Entity type:Organization
Organization Name:DEEP BLUE BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMAN-BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-279-3725
Mailing Address - Street 1:1710 KELLER PKWY # 2910
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3749
Mailing Address - Country:US
Mailing Address - Phone:469-279-3725
Mailing Address - Fax:
Practice Address - Street 1:10339 TWISTING SPRINGS DR
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1054
Practice Address - Country:US
Practice Address - Phone:469-279-3725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty