Provider Demographics
NPI:1538934815
Name:CANTU, NICOLIS KRISTIAN (RBT)
Entity type:Individual
Prefix:
First Name:NICOLIS
Middle Name:KRISTIAN
Last Name:CANTU
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 N INTERSTATE 35 APT 333A
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6574
Mailing Address - Country:US
Mailing Address - Phone:210-367-0647
Mailing Address - Fax:
Practice Address - Street 1:207 ELMHURST
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5981
Practice Address - Country:US
Practice Address - Phone:210-367-0647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23257518106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician