Provider Demographics
NPI:1386421659
Name:OMNIA BEHAVIORAL HEALTH, PLLC
Entity type:Organization
Organization Name:OMNIA BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLLYNNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:214-735-8496
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-0196
Mailing Address - Country:US
Mailing Address - Phone:254-863-8075
Mailing Address - Fax:
Practice Address - Street 1:935 PARK DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2509
Practice Address - Country:US
Practice Address - Phone:254-863-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty