Provider Demographics
NPI:1558050542
Name:COLORFUL BREAKTHROUGH IN ABA PLLC
Entity Type:Organization
Organization Name:COLORFUL BREAKTHROUGH IN ABA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AGUILLON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:956-270-9262
Mailing Address - Street 1:21750 HARDY OAK BLVD STE 104 PMB 553984
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:956-270-9262
Mailing Address - Fax:956-394-1288
Practice Address - Street 1:6418 AZUL ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-0723
Practice Address - Country:US
Practice Address - Phone:956-270-9262
Practice Address - Fax:956-394-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty