Provider Demographics
NPI:1316713860
Name:TELLEZ ESTRADA, MARIA DANIELA (RBT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DANIELA
Last Name:TELLEZ ESTRADA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:TELLEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:3006 BEE CAVES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5588
Mailing Address - Country:US
Mailing Address - Phone:512-328-5599
Mailing Address - Fax:
Practice Address - Street 1:3006 BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5588
Practice Address - Country:US
Practice Address - Phone:512-328-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-293086106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-23-293086OtherBEHAVIOR TECHNICIAN