Provider Demographics
NPI:1801224522
Name:PACED BEHAVIOR, LLC
Entity Type:Organization
Organization Name:PACED BEHAVIOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:210-702-0515
Mailing Address - Street 1:5215 ANEMONE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6372
Mailing Address - Country:US
Mailing Address - Phone:210-702-0515
Mailing Address - Fax:210-200-6056
Practice Address - Street 1:5215 ANEMONE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6372
Practice Address - Country:US
Practice Address - Phone:210-702-0515
Practice Address - Fax:210-200-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty