Provider Demographics
NPI:1033506985
Name:ACHIEVEMENT, BALANCE, COMMUNITY, PEDIATRICS
Entity Type:Organization
Organization Name:ACHIEVEMENT, BALANCE, COMMUNITY, PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:214-616-2932
Mailing Address - Street 1:830 PARKER SQ
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7429
Mailing Address - Country:US
Mailing Address - Phone:214-616-2932
Mailing Address - Fax:
Practice Address - Street 1:830 PARKER SQ
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7429
Practice Address - Country:US
Practice Address - Phone:214-616-2932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-06-2769103K00000X
TX56129103TB0200X, 1041C0700X
TX2251P0200X, 225XP0200X
TX19493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty