Healthcare Provider Details

I. General information

NPI: 1730831579
Provider Name (Legal Business Name): ALICIA SOLIS ESCALANTE M.ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4907 AVENUE F APT A
AUSTIN TX
78751-2518
US

IV. Provider business mailing address

4907 AVENUE F APT A
AUSTIN TX
78751-2518
US

V. Phone/Fax

Practice location:
  • Phone: 210-542-7877
  • Fax:
Mailing address:
  • Phone: 210-542-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-55221
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: