Provider Demographics
NPI:1558774513
Name:ENDEAVOR BEHAVIORAL INSTITUTE LLC
Entity Type:Organization
Organization Name:ENDEAVOR BEHAVIORAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:832-405-9590
Mailing Address - Street 1:1316 CROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-4122
Mailing Address - Country:US
Mailing Address - Phone:832-405-9590
Mailing Address - Fax:
Practice Address - Street 1:1316 CROCKETT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-4122
Practice Address - Country:US
Practice Address - Phone:832-405-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-10-7334103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty