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General NPI Number Information
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NPI Number | 1598581761
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Entity Type | Individual
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Provider Name | CRYSTAL LENIQUE SUMMERHILL RBT
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Gender | Female
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 108 W RUSSELL ST
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City | WEATHERFORD
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State | TX
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Zip | 76086-5360
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Country | US
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Telephone | 817-694-5073
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Fax |
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Provider Business Mailing Address
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Address Line | 3627 ORCHARD ST
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7198
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Country | US
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Telephone | 469-343-6390
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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-24-342440
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License Number State | TX
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