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General NPI Number Information
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NPI Number | 1891486270
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Entity Type | Individual
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Provider Name | DELAYNEY JAYDE FOUNTAIN
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Gender | Female
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 12740 BANDERA RD
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City | HELOTES
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State | TX
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Zip | 78023-4327
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Country | US
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Telephone | 210-321-9275
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Fax |
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Provider Business Mailing Address
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Address Line | 108 WESTERLY PL
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City | CIBOLO
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State | TX
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Zip | 78108-3207
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Country | US
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Telephone | 210-954-8626
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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 |
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License Number State |
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