Basic Information
| Provider Information | |||||||||
| NPI: | 1003421504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | PAYAL | ||||||||
| MiddleName: | DHRUV | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5606 E 51ST ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787236144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312200263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1310 W SLAUGHTER LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787486556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883083728 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2020 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-20-43212 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.