Provider Demographics
NPI:1902601792
Name:GOMEZ, KEILA BEATRIZ (RBT)
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:BEATRIZ
Last Name:GOMEZ
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 1:4010 STREAMBED TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-1459
Mailing Address - Country:US
Mailing Address - Phone:941-296-4325
Mailing Address - Fax:
Practice Address - Street 1:4010 STREAMBED TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-1459
Practice Address - Country:US
Practice Address - Phone:941-296-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-398496106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician