Healthcare Provider Details

I. General information

NPI: 1457118432
Provider Name (Legal Business Name): ELIZABETHE NICOLE HURD RBT-24-329509
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 CARSON HL STE 202
SAN ANTONIO TX
78251-5500
US

IV. Provider business mailing address

419 CARSON HL STE 202
SAN ANTONIO TX
78251-5500
US

V. Phone/Fax

Practice location:
  • Phone: 210-634-1129
  • Fax:
Mailing address:
  • Phone: 210-634-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-329509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: