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General NPI Number Information
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NPI Number | 1568059517
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Entity Type | Individual
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Provider Name | AJISHA MONIQUE SUTTON BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 11006 RIVER STROLL ST
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City | SAN ANTONIO
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State | TX
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Zip | 78230-2524
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Country | US
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Telephone | 855-374-4900
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Fax | 855-322-3694
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Provider Business Mailing Address
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Address Line | 3936 FREDERICKBURG ROAD APT# 1504
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City | SAN ANTONIO
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State | TX
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Zip | 78201-2964
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Country | US
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Telephone | 210-769-0924
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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 | 1-23-67346
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License Number State | TX
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