Provider Demographics
NPI:1679932362
Name:LONE STAR ABA BEHAVIORAL SERVICES AND SUPPORTS
Entity type:Organization
Organization Name:LONE STAR ABA BEHAVIORAL SERVICES AND SUPPORTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST-DOCTORAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:GAINEY
Authorized Official - Last Name:ADAMI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:512-940-3869
Mailing Address - Street 1:9311 DIAMANTE DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703 PLACID LAKE LN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-5276
Practice Address - Country:US
Practice Address - Phone:512-940-3869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01096323103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty