Healthcare Provider Details

I. General information

NPI: 1972175560
Provider Name (Legal Business Name): PRESLEY CRUTSINGER RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 SOUTHWEST BLVD
BENBROOK TX
76132-1080
US

IV. Provider business mailing address

937 HILLTOP DR
WEATHERFORD TX
76086-5845
US

V. Phone/Fax

Practice location:
  • Phone: 817-249-8100
  • Fax:
Mailing address:
  • Phone: 817-415-2759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: