Healthcare Provider Details

I. General information

NPI: 1821574559
Provider Name (Legal Business Name): PASSIONA LA'VELLE THOMPSON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3552 FM 1092 RD
MISSOURI CITY TX
77459
US

IV. Provider business mailing address

3552 FM 1092
MISSOURI CITY TX
77459
US

V. Phone/Fax

Practice location:
  • Phone: 346-368-4412
  • Fax:
Mailing address:
  • Phone: 346-368-4412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-3542
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: