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NPI Code Detail

MEDICARE: ANGELIA MEADOW LARRIVIERE M.A, BCBA, LBA

MEDICARE: ANGELIA MEADOW LARRIVIERE M.A, BCBA, LBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1396529806
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELIA MEADOW LARRIVIERE M.A, BCBA, LBA
Provider Business Mailing Address
First Line : 4917 GOLDEN TRIANGLE BLVD STE 411
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4672
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4917 GOLDEN TRIANGLE BLVD STE 411
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4672
Country : US
Telephone Number : 817-754-4938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2023
Last Update Date : 03/13/2026

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