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NPI Code Detail

MEDICARE: PATRICIA ELLIS MA, BCBA, LBA

MEDICARE: PATRICIA ELLIS MA, 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
1103K00000XBehavior Analyst2773TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RBT-17-39939OTHERBACB

General Provider Information

NPI Number : 1801352794
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA ELLIS MA, BCBA, LBA
Provider Business Mailing Address
First Line : 1012 COMMERCIAL BLVD N
Second Line :
City : ARLINGTON
State : TX
Zip : 76001-7119
Country : US
Telephone Number : 817-557-8040
Fax Number :
Provider Business Practice Location Address
First Line : 1012 COMMERCIAL BLVD N
Second Line :
City : ARLINGTON
State : TX
Zip : 76001-7119
Country : US
Telephone Number : 817-557-8040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2019
Last Update Date : 02/17/2025

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