Healthcare Provider Details

I. General information

NPI: 1538745393
Provider Name (Legal Business Name): ELIANA BUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 KELLER HICKS RD
FORT WORTH TX
76244-9610
US

IV. Provider business mailing address

1002 JEWELL ST
AUSTIN TX
78704-3432
US

V. Phone/Fax

Practice location:
  • Phone: 940-222-8556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number4878
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-137311
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number5081
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: