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NPI Code Detail

MEDICARE: MONICA MARIA REVELEY RBT

MEDICARE: MONICA MARIA REVELEY RBT
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-16-15316TX
2103K00000XBehavior Analyst2541TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12541OTHERTXLICENSED BEHAVIOR ANALYST
21-18-31432OTHERTXBOARD CERTIFIED BEHAVIOR ANALYST

General Provider Information

NPI Number : 1114428687
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA MARIA REVELEY RBT
Provider Business Mailing Address
First Line : 7700 N CAPITAL OF TEXAS HWY APT 1325
Second Line :
City : AUSTIN
State : TX
Zip : 78731-1177
Country : US
Telephone Number : 210-315-9713
Fax Number :
Provider Business Practice Location Address
First Line : 2105 E PARK ST
Second Line :
City : CEDAR PARK
State : TX
Zip : 78613-4598
Country : US
Telephone Number : 512-588-1362
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2018
Last Update Date : 07/30/2020

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Directions to “ MONICA MARIA REVELEY RBT” Practice Location

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