Healthcare Provider Details

I. General information

NPI: 1720915408
Provider Name (Legal Business Name): RANDI LYNN MATTHEWS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 9TH ST
ALAMOGORDO NM
88310-6416
US

IV. Provider business mailing address

3023 SUNRISE AVE
ALAMOGORDO NM
88310-4046
US

V. Phone/Fax

Practice location:
  • Phone: 575-495-9911
  • Fax:
Mailing address:
  • Phone: 575-415-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1575253
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: