Provider Demographics
NPI:1982472841
Name:BLUEPRINT BEHAVIORAL HEALTH THERAPY
Entity Type:Organization
Organization Name:BLUEPRINT BEHAVIORAL HEALTH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MARULL
Authorized Official - Suffix:
Authorized Official - Credentials:LBA, BCBA
Authorized Official - Phone:405-657-7433
Mailing Address - Street 1:1960 E RENEE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-3062
Mailing Address - Country:US
Mailing Address - Phone:405-657-7433
Mailing Address - Fax:
Practice Address - Street 1:1960 E RENEE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-3062
Practice Address - Country:US
Practice Address - Phone:405-657-7433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty