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General NPI Number Information
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NPI Number | 1821695305
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Entity Type | Individual
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Provider Name | ZACHARY SMITH
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Gender | Male
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 14058 MEMORIAL DR
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City | HOUSTON
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State | TX
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Zip | 77079-6848
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Country | US
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Telephone | 281-752-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 935 WAX MYRTLE LN
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City | HOUSTON
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State | TX
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Zip | 77079-3772
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Country | US
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Telephone | 832-622-2257
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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-20-134331
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License Number State | TX
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