MEDICARE: MIRELLE ELIZABETH DEVENNEY

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
1	106S00000X	Behavior Technician
2	2355S0801X	Speech-Language Assistant	40201	TX
3	103K00000X	Behavior Analyst	3537	TX

General Provider Information

NPI Number	:	1215278247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRELLE ELIZABETH DEVENNEY

Provider Business Mailing Address
First Line	:	16782 VON KARMAN AVE STE 11
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92606-2417
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 S MESA HILLS DR BLDG 3
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5568
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:	619-374-7134

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

Provider Enumeration Date	:	03/15/2013
Last Update Date	:	08/23/2021

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Directions to “ MIRELLE ELIZABETH DEVENNEY ” Practice Location

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