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General NPI Number Information
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NPI Number | 1043087828
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Entity Type | Organization
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Legal Business Name | BUITRON BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 6669 N EXETER LN APT 103
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City | MERIDIAN
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State | ID
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Zip | 83646-1582
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Country | US
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Telephone | 951-392-0237
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1658
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City | MERIDIAN
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State | ID
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Zip | 83680-1658
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Country | US
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Telephone | 951-392-0237
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA RUBY FUENTES
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Credential |
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Telephone | 951-392-0237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 |
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License Number State |
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Taxonomy #3
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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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