Provider Demographics
NPI:1932805421
Name:THE BEHAVIORAL WELLNESS ACADEMY, PLLC
Entity Type:Organization
Organization Name:THE BEHAVIORAL WELLNESS ACADEMY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRANIKA
Authorized Official - Middle Name:LASHANN
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D, LBA
Authorized Official - Phone:979-574-1984
Mailing Address - Street 1:9423 GRAND SPARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-3375
Mailing Address - Country:US
Mailing Address - Phone:979-574-1984
Mailing Address - Fax:281-754-4320
Practice Address - Street 1:9423 GRAND SPARK DR
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-3375
Practice Address - Country:US
Practice Address - Phone:979-574-1984
Practice Address - Fax:281-754-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty