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NPI Code Detail

MEDICARE: TATYANNA C SMITH BT

MEDICARE: TATYANNA C SMITH BT
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 Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1822-645-485OTHERBLUESPRIG PEDIATRICS

General Provider Information

NPI Number : 1861014847
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATYANNA C SMITH BT
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 : 281-651-5120
Fax Number :
Provider Business Practice Location Address
First Line : 25925 BUDDE RD
Second Line :
City : SPRING
State : TX
Zip : 77380-2011
Country : US
Telephone Number : 281-465-4468
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2020
Last Update Date : 05/12/2020

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Directions to “ TATYANNA C SMITH BT” Practice Location

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