MEDICARE: LESLEY YANETH RIVAS LOPEZ

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	BACB1579629	TX

General Provider Information

NPI Number	:	1215862529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY YANETH RIVAS LOPEZ

Provider Business Mailing Address
First Line	:	913 E SPRING ST
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-8125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	913 E SPRING ST
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-8125
Country	:	US
Telephone Number	:	580-706-6939
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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