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NPI Code Detail

MEDICARE: MRS. JESSICA SMITH BCBA, LBA

MEDICARE: MRS. JESSICA SMITH BCBA, LBA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-21-55190TX

General Provider Information

NPI Number : 1518479591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA SMITH BCBA, LBA
Provider Business Mailing Address
First Line : 7500 SAN FELIPE ST STE 990
Second Line :
City : HOUSTON
State : TX
Zip : 77063-1708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7608 NARROW PASS ST
Second Line :
City : LIVE OAK
State : TX
Zip : 78233-3019
Country : US
Telephone Number : 210-714-3545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2017
Last Update Date : 11/20/2025

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