Provider Demographics
NPI:1841663275
Name:RUTLAND, SEAN WILLIAM (MS BCBA)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:WILLIAM
Last Name:RUTLAND
Suffix:
Gender:M
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 WASHINGTON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-1004
Mailing Address - Country:US
Mailing Address - Phone:972-427-1990
Mailing Address - Fax:
Practice Address - Street 1:3041 WASHINGTON DR STE 100
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-1004
Practice Address - Country:US
Practice Address - Phone:972-427-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
TX2626103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist