MEDICARE: PASSIONA LA'VELLE THOMPSON RBT

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-17-3542	TX

General Provider Information

NPI Number	:	1821574559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PASSIONA LA'VELLE THOMPSON RBT

Provider Business Mailing Address
First Line	:	3552 FM 1092
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459
Country	:	US
Telephone Number	:	346-368-4412
Fax Number	:

Provider Business Practice Location Address
First Line	:	3552 FM 1092 RD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459
Country	:	US
Telephone Number	:	346-368-4412
Fax Number	:

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

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	07/16/2018

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