Provider Demographics
NPI:1215692082
Name:ORELLANA, DESTINY SAMANTHA
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:SAMANTHA
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 HILLCREST RD STE 111
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5418
Mailing Address - Country:US
Mailing Address - Phone:469-535-3844
Mailing Address - Fax:
Practice Address - Street 1:4500 HILLCREST RD STE 111
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5418
Practice Address - Country:US
Practice Address - Phone:469-535-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician