MEDICARE: AYRIELLE GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician	RBT-20-117766
3	103K00000X	Behavior Analyst	1-22-62152

General Provider Information

NPI Number	:	1043835523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYRIELLE GONZALEZ

Provider Business Mailing Address
First Line	:	3527 BEAU LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77039-5706
Country	:	US
Telephone Number	:	832-758-4291
Fax Number	:

Provider Business Practice Location Address
First Line	:	9240 N SAM HOUSTON PKWY E
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-5141
Country	:	US
Telephone Number	:	832-562-3189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	10/23/2022

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Directions to “ AYRIELLE GONZALEZ ” Practice Location

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