MEDICARE: LISSETTE BILLINGSLEY BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1417420357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISSETTE BILLINGSLEY BCBA

Provider Business Mailing Address
First Line	:	6914 BRISBANE CT STE 200
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4924
Country	:	US
Telephone Number	:	844-272-7223
Fax Number	:

Provider Business Practice Location Address
First Line	:	8540 BROADWAY ST STE 102
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7710
Country	:	US
Telephone Number	:	844-272-7223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	09/16/2024

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