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General NPI Number Information
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NPI Number | 1497219828
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Entity Type | Individual
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Provider Name | SELENA ANTUNEZ
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Gender | Female
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 4441 BRYANT IRVIN RD N
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City | FORT WORTH
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State | TX
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Zip | 76107-7338
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Country | US
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Telephone | 817-402-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 COBBLERS LN APT D
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City | KISSIMMEE
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State | FL
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Zip | 34744-5558
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Country | US
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Telephone | 407-243-7231
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-23-67154
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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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