The Shape of Behavior

Primary specialty

SpecialistTaxonomy code 174400000X

License

1-00-0350 Issued in TX

Legal business name

THE SHAPE OF BEHAVIOR

Practice address

12941 North Fwy
Ste 750
Houston, TX 77060-1240

Phone

(832) 358-2655

Fax

(832) 359-3530

NPI assigned

Jun 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Domonique Y Randall, M.S. BCBA

Title

Owner

Phone

(832) 358-2655

Specialties & licenses 1

Addresses

Tax ID family

The Shape of Behavior2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The Shape of Behavior, Inc

  • Psychologist
  • Houston, TX
  • NPI 1891162111
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1255537338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12941 NORTH FWY",
            "address_2": "STE 750",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770601240",
            "telephone_number": "832-358-2655",
            "fax_number": "832-359-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12941 NORTH FWY",
            "address_2": "STE 750",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770601240",
            "telephone_number": "832-358-2655",
            "fax_number": "832-359-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SHAPE OF BEHAVIOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "DOMONIQUE",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "832-358-2655",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S. BCBA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "1-00-0350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Houston, TX
• Providers in Houston, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.