Healthcare Provider Details

I. General information

NPI: 1518548247
Provider Name (Legal Business Name): DAIJAH MARIE MONTES RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4927 LAKE RIDGE PKWY STE 120
GRAND PRAIRIE TX
75052-3066
US

IV. Provider business mailing address

12240 INDIAN CREEK CT
BELTSVILLE MD
20705-1242
US

V. Phone/Fax

Practice location:
  • Phone: 214-251-8758
  • Fax:
Mailing address:
  • Phone: 201-979-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT21162051
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: