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NPI Code Detail

MEDICARE: SELEEHOM YISIHAK BCBA, LBA

MEDICARE: SELEEHOM YISIHAK 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
1106S00000XBehavior TechnicianRBT-19-95535TX
2103K00000XBehavior Analyst1-22-62518TX

General Provider Information

NPI Number : 1952957359
Entity Type Code : Individual
Provider Name (Legal Business Name) : SELEEHOM YISIHAK BCBA, LBA
Provider Business Mailing Address
First Line : 903 PROTON RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-4203
Country : US
Telephone Number : 210-228-9923
Fax Number :
Provider Business Practice Location Address
First Line : 600 N LOOP 1604 E
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78232-1268
Country : US
Telephone Number : 210-239-0066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2019
Last Update Date : 11/17/2022

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