Healthcare Provider Details

I. General information

NPI: 1245940683
Provider Name (Legal Business Name): GRACE OLIVIA HUFFMAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ROYAL LN STE 300
DALLAS TX
75229-3179
US

IV. Provider business mailing address

4050 CREEKDALE DR
DALLAS TX
75229-5302
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 214-695-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB827476
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: