Provider Demographics
NPI:1104445055
Name:GARRISON, CALLIE (RBT)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-7342
Mailing Address - Country:US
Mailing Address - Phone:214-930-1872
Mailing Address - Fax:
Practice Address - Street 1:920 HIGHWAY 352 STE 200
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6806
Practice Address - Country:US
Practice Address - Phone:468-828-8248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-114417106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-20-114417OtherBACB