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General NPI Number Information
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NPI Number | 1013593474
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Entity Type | Individual
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Provider Name | CHEYENNE ROSS
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Gender | Female
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 1537 E GRANDE BLVD
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City | TYLER
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State | TX
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Zip | 75703-3900
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Country | US
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Telephone | 512-401-3612
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Fax |
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Provider Business Mailing Address
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Address Line | 4091 HOGAN DR UNIT 3106
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City | TYLER
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State | TX
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Zip | 75709-7007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 6919
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License Number State | TX
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