Healthcare Provider Details

I. General information

NPI: 1164922126
Provider Name (Legal Business Name): ELIZABETH LLAMAS M.ED. BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 RIVER BEND DR STE 100
DALLAS TX
75247-4934
US

IV. Provider business mailing address

1330 RIVER BEND DR STE 100
DALLAS TX
75247-4934
US

V. Phone/Fax

Practice location:
  • Phone: 214-333-7076
  • Fax:
Mailing address:
  • Phone: 214-333-7076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11728483
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: