MEDICARE: KRYSTAL COMPTON

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	106S00000X	Behavior Technician	RBT-16-26226	TX
2	103K00000X	Behavior Analyst	6941	TX
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1528540200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL COMPTON

Provider Business Mailing Address
First Line	:	2205 WILLIAMS TRACE BLVD STE 101
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 WILLIAMS TRACE BLVD STE 101
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4443
Country	:	US
Telephone Number	:	855-782-2822
Fax Number	:

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

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	04/26/2024

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Directions to “ KRYSTAL COMPTON ” Practice Location

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