Provider Demographics
NPI:1417383589
Name:TECHNOLOGY ENHANCED LEARNING AND LIVING
Entity Type:Organization
Organization Name:TECHNOLOGY ENHANCED LEARNING AND LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDD-WALL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:512-807-8955
Mailing Address - Street 1:223 W ANDERSON LN
Mailing Address - Street 2:#A115
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1131
Mailing Address - Country:US
Mailing Address - Phone:512-807-8955
Mailing Address - Fax:866-561-4982
Practice Address - Street 1:223 W ANDERSON LN
Practice Address - Street 2:#A115
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1131
Practice Address - Country:US
Practice Address - Phone:512-807-8955
Practice Address - Fax:866-561-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty