MEDICARE: KASSANDRA ISABEL RIVAS 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
1	103K00000X	Behavior Analyst	3334	TX

General Provider Information

NPI Number	:	1225664048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA ISABEL RIVAS BCBA

Provider Business Mailing Address
First Line	:	1155 BRITTMOORE RD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-5034
Country	:	US
Telephone Number	:	713-932-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 BRITTMOORE RD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-5034
Country	:	US
Telephone Number	:	713-932-0074
Fax Number	:

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

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	03/13/2020

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