Provider Demographics
NPI:1952862013
Name:PIVOTAL BEHAVIORS LEARNING CENTER LLC
Entity Type:Organization
Organization Name:PIVOTAL BEHAVIORS LEARNING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEWRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDDUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-303-8208
Mailing Address - Street 1:12406 SKYVIEW CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-1406
Mailing Address - Country:US
Mailing Address - Phone:832-303-8208
Mailing Address - Fax:
Practice Address - Street 1:12406 SKYVIEW CRESCENT CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-1406
Practice Address - Country:US
Practice Address - Phone:832-303-8208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty