=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689276057
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELA GRANADOS BCBA, LBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2020
-----------------------------------------------------
Last Update Date | 11/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28286 BOERNE STAGE RD #3
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-816-5510
-----------------------------------------------------
Fax | 855-421-1717
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28286 BOERNE STAGE RD #3
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-816-5510
-----------------------------------------------------
Fax | 855-421-1717
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | 1-24-76439
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 7622
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------