Healthcare Provider Details

I. General information

NPI: 1841663275
Provider Name (Legal Business Name): SEAN WILLIAM RUTLAND M.S. BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 WASHINGTON DR STE 100
MELISSA TX
75454-1004
US

IV. Provider business mailing address

3041 WASHINGTON DR STE 100
MELISSA TX
75454-1004
US

V. Phone/Fax

Practice location:
  • Phone: 972-427-1990
  • Fax:
Mailing address:
  • Phone: 972-427-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2626
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: