MEDICARE: ALLISON LIVERANCE

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

General Provider Information

NPI Number	:	1255016903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON LIVERANCE

Provider Business Mailing Address
First Line	:	6509 TOM STOCK ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76116-2134
Country	:	US
Telephone Number	:	810-941-2710
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 HOUSTON ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-7429
Country	:	US
Telephone Number	:	817-861-5000
Fax Number	:

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

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “ ALLISON LIVERANCE ” Practice Location

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