Healthcare Provider Details

I. General information

NPI: 1629527544
Provider Name (Legal Business Name): EMILY DAWN KISSLING BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 07/22/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15911 NACOGDOCHES RD
SAN ANTONIO TX
78247-1107
US

IV. Provider business mailing address

15911 NACOGDOCHES RD
SAN ANTONIO TX
78247-1107
US

V. Phone/Fax

Practice location:
  • Phone: 210-599-7733
  • Fax: 210-599-3105
Mailing address:
  • Phone: 210-599-7733
  • Fax: 210-599-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-23875
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: