Healthcare Provider Details

I. General information

NPI: 1699686964
Provider Name (Legal Business Name): ADRIANA BENTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANA CRUZ

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E LOOP 281 STE B1
LONGVIEW TX
75605-7969
US

IV. Provider business mailing address

450 E LOOP 281 STE B1
LONGVIEW TX
75605-7969
US

V. Phone/Fax

Practice location:
  • Phone: 903-757-7731
  • Fax: 903-757-3756
Mailing address:
  • Phone: 903-757-7731
  • Fax: 903-757-3756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: