Healthcare Provider Details

I. General information

NPI: 1205507621
Provider Name (Legal Business Name): SABRINA LYTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SABRINA BABB

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5022 TENNYSON PKWY
PLANO TX
75024-3151
US

IV. Provider business mailing address

PO BOX 33568
SAN DIEGO CA
92163-3568
US

V. Phone/Fax

Practice location:
  • Phone: 855-223-7123
  • Fax: 619-374-7134
Mailing address:
  • Phone: 855-223-7123
  • Fax: 619-374-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-169422
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71253
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14773
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: