Provider Demographics
NPI:1467991935
Name:ROGUE ABA TEXAS LLC
Entity type:Organization
Organization Name:ROGUE ABA TEXAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:CARLI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-692-8173
Mailing Address - Street 1:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92079-1808
Mailing Address - Country:US
Mailing Address - Phone:603-692-8173
Mailing Address - Fax:
Practice Address - Street 1:2112 SW H K DODGEN LOOP STE 183
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7014
Practice Address - Country:US
Practice Address - Phone:603-692-8173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306251442OtherNPI (INDIVIDUAL)