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NPI Code Detail

MEDICARE: MISS MARIAH GONZALES GONZALES BCBA

MEDICARE: MISS MARIAH GONZALES GONZALES BCBA
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-18-48830TX
2103K00000XBehavior Analyst1-21-51028TX

General Provider Information

NPI Number : 1215589163
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MARIAH GONZALES GONZALES BCBA
Provider Business Mailing Address
First Line : 125 PECANWOOD S
Second Line :
City : KYLE
State : TX
Zip : 78640-5265
Country : US
Telephone Number : 361-739-6824
Fax Number :
Provider Business Practice Location Address
First Line : 1310 W SLAUGHTER LN
Second Line :
City : AUSTIN
State : TX
Zip : 78748-6556
Country : US
Telephone Number : 888-308-3728
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2019
Last Update Date : 06/30/2021

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