MEDICARE: DENASIA TASHAE WINSTON

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

General Provider Information

NPI Number	:	1811774078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENASIA TASHAE WINSTON

Provider Business Mailing Address
First Line	:	110 LOWES BLVD UNIT A
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-6782
Country	:	US
Telephone Number	:	309-218-6778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3106 S W S YOUNG DR STE 105
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-2007
Country	:	US
Telephone Number	:	325-450-5042
Fax Number	:

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

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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