Provider Demographics
NPI:1003376336
Name:LEAP APPLIED BEHAVIORAL SERVICE
Entity Type:Organization
Organization Name:LEAP APPLIED BEHAVIORAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GATHURA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:469-642-8455
Mailing Address - Street 1:706 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4568
Mailing Address - Country:US
Mailing Address - Phone:469-642-8455
Mailing Address - Fax:
Practice Address - Street 1:706 W CENTER ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4568
Practice Address - Country:US
Practice Address - Phone:469-642-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty