Healthcare Provider Details

I. General information

NPI: 1326627241
Provider Name (Legal Business Name): DYLAN P ODONNELL RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 ABRAMS RD
DALLAS TX
75214-2000
US

IV. Provider business mailing address

6640 ASCOT LN
DALLAS TX
75214-6304
US

V. Phone/Fax

Practice location:
  • Phone: 469-906-6372
  • Fax:
Mailing address:
  • Phone: 214-507-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: