Provider Demographics
NPI:1164108791
Name:BOUNDLESS BEHAVIOR THERAPY LLC
Entity Type:Organization
Organization Name:BOUNDLESS BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOUDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:815-514-0818
Mailing Address - Street 1:7342 BRIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-9104
Mailing Address - Country:US
Mailing Address - Phone:815-514-0818
Mailing Address - Fax:
Practice Address - Street 1:7342 BRIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-9104
Practice Address - Country:US
Practice Address - Phone:815-514-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty