Provider Demographics
NPI:1942926522
Name:POLESTAR ABA THERAPY LLC
Entity Type:Organization
Organization Name:POLESTAR ABA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEKUNLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-800-1061
Mailing Address - Street 1:16100 CAIRNWAY DR STE 353
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3597
Mailing Address - Country:US
Mailing Address - Phone:281-800-1061
Mailing Address - Fax:
Practice Address - Street 1:16100 CAIRNWAY DR STE 353
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3597
Practice Address - Country:US
Practice Address - Phone:281-800-1061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty