Provider Demographics
NPI:1851930515
Name:BLUEBONNET AUTISM PLLC
Entity Type:Organization
Organization Name:BLUEBONNET AUTISM PLLC
Other - Org Name:BLUEBONNET AUTISM PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:832-273-9481
Mailing Address - Street 1:2121 EL PASEO ST APT 1108
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3223
Mailing Address - Country:US
Mailing Address - Phone:832-273-9481
Mailing Address - Fax:
Practice Address - Street 1:630 COLONY LAKE ESTATES DR APT 1014
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4675
Practice Address - Country:US
Practice Address - Phone:832-273-9481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-29
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty