Healthcare Provider Details

I. General information

NPI: 1528623337
Provider Name (Legal Business Name): ALEXANDRIA BETHANY SALAS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W GREEN OAKS BLVD
ARLINGTON TX
76013-8314
US

IV. Provider business mailing address

4118 CORONET LN
ARLINGTON TX
76017-2330
US

V. Phone/Fax

Practice location:
  • Phone: 817-457-3088
  • Fax:
Mailing address:
  • Phone: 214-998-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number6541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: