Provider Demographics
NPI:1609356096
Name:PUSH CONSULTANTS LLC
Entity Type:Organization
Organization Name:PUSH CONSULTANTS LLC
Other - Org Name:ALL THINGS ARE POSSIBLE 4 AUTISM; ALL THINGS ARE POSSIBLE 4 U;
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KOTEKA
Authorized Official - Middle Name:SHANTAL
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-471-5132
Mailing Address - Street 1:PO BOX 5395
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-5395
Mailing Address - Country:US
Mailing Address - Phone:318-918-0671
Mailing Address - Fax:903-471-5133
Practice Address - Street 1:1305 ARKANSAS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1691
Practice Address - Country:US
Practice Address - Phone:970-330-9702
Practice Address - Fax:870-330-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106E00000X, 106S00000X
TX251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372338903Medicaid
AR233582526Medicaid
TX372338902Medicaid
TX387169101Medicaid