Provider Demographics
NPI:1790416790
Name:ACTIVE BEHAVIORAL GOALS LLC
Entity Type:Organization
Organization Name:ACTIVE BEHAVIORAL GOALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-927-4409
Mailing Address - Street 1:13242 HUNTERS BREEZE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2867
Mailing Address - Country:US
Mailing Address - Phone:347-927-4409
Mailing Address - Fax:
Practice Address - Street 1:13242 HUNTERS BREEZE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2867
Practice Address - Country:US
Practice Address - Phone:347-927-4409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty