Provider Demographics
NPI:1588994859
Name:JAWANDA NEWSOME ABA AND BEHAVIORAL SERVICES, LLC
Entity type:Organization
Organization Name:JAWANDA NEWSOME ABA AND BEHAVIORAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBIN-NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:210-885-3481
Mailing Address - Street 1:1027 WINDY POND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2596
Mailing Address - Country:US
Mailing Address - Phone:210-885-3481
Mailing Address - Fax:210-858-3853
Practice Address - Street 1:1027 WINDY POND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-2596
Practice Address - Country:US
Practice Address - Phone:210-885-3481
Practice Address - Fax:210-858-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-07-3487103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty