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General NPI Number Information
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NPI Number | 1710844352
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Entity Type | Individual
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Provider Name | ALICIA BLACK
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Gender | Female
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 171 DEEP WOOD DR STE 104
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City | ROUND ROCK
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State | TX
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Zip | 78681-4935
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Country | US
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Telephone | 512-910-3251
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Fax |
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Provider Business Mailing Address
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Address Line | 13628 GREGG MANOR RD
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City | MANOR
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State | TX
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Zip | 78653-3358
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Country | US
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Telephone | 720-435-6189
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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 | 25-499179
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License Number State | TX
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