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General NPI Number Information
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NPI Number | 1144004128
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Entity Type | Individual
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Provider Name | AMY LYNN RIDDLE RBT
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Gender | Female
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 2400 ELLIS ST
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City | VENUS
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State | TX
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Zip | 76084-3777
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Country | US
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Telephone | 682-877-1234
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Fax | 682-877-1235
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Provider Business Mailing Address
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Address Line | 1001 BELLCREST DR
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City | ARLINGTON
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State | TX
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Zip | 76002-5532
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Country | US
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Telephone | 315-804-2441
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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 | RBT-23-286529
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License Number State |
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