Provider Demographics
NPI:1659794345
Name:A-MAZE AUTISM AND BEHAVIOR SUPPORT LLC
Entity Type:Organization
Organization Name:A-MAZE AUTISM AND BEHAVIOR SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MED BCBA
Authorized Official - Phone:469-585-8184
Mailing Address - Street 1:1935 MAXWELL DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7577
Mailing Address - Country:US
Mailing Address - Phone:469-585-8184
Mailing Address - Fax:
Practice Address - Street 1:1935 MAXWELL DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-7577
Practice Address - Country:US
Practice Address - Phone:469-585-8184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-6597103K00000X, 251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty