Provider Demographics
NPI:1063883262
Name:MATCHETT, JESSICA (BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MATCHETT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 S AW GRIMES BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7429
Mailing Address - Country:US
Mailing Address - Phone:512-661-4387
Mailing Address - Fax:512-717-5553
Practice Address - Street 1:1250 S AW GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7429
Practice Address - Country:US
Practice Address - Phone:512-661-4387
Practice Address - Fax:512-717-5553
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1-15-20086103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1487OtherSTATE LICENSE