Provider Demographics
NPI:1760119689
Name:ABASWF OF TEXAS CORP
Entity Type:Organization
Organization Name:ABASWF OF TEXAS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUCEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-628-6999
Mailing Address - Street 1:5318 WESLAYAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1048
Mailing Address - Country:US
Mailing Address - Phone:239-628-6999
Mailing Address - Fax:
Practice Address - Street 1:6660 ESTERO BLVD
Practice Address - Street 2:UNIT B404
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931
Practice Address - Country:US
Practice Address - Phone:239-628-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty