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General NPI Number Information
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NPI Number | 1215589163
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Entity Type | Individual
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Provider Name | MARIAH GONZALES GONZALES BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 1310 W SLAUGHTER LN
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City | AUSTIN
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State | TX
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Zip | 78748-6556
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Country | US
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Telephone | 888-308-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 125 PECANWOOD S
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City | KYLE
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State | TX
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Zip | 78640-5265
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Country | US
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Telephone | 361-739-6824
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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-18-48830
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License Number State | TX
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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 | 1-21-51028
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License Number State | TX
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