MEDICARE: DAVID BRYAN RIVERS BEHAVIOR ANALYST

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	1-13-12826	TX

General Provider Information

NPI Number	:	1427477322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BRYAN RIVERS BEHAVIOR ANALYST

Provider Business Mailing Address
First Line	:	13101 PALANCAR DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-1348
Country	:	US
Telephone Number	:	979-492-9039
Fax Number	:

Provider Business Practice Location Address
First Line	:	13101 PALANCAR DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-1348
Country	:	US
Telephone Number	:	979-492-9039
Fax Number	:

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	09/29/2021

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