Basic Information
| Provider Information | |||||||||
| NPI: | 1023471950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINTANILLA | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.ED., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3006 BEE CAVES RD | ||||||||
| Address2: | SUITE B200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787465588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123285599 | ||||||||
| FaxNumber: | 5123285585 | ||||||||
| Practice Location | |||||||||
| Address1: | 3006 BEE CAVES RD | ||||||||
| Address2: | SUITE B200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787465588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123285599 | ||||||||
| FaxNumber: | 5123285585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2016 | ||||||||
| LastUpdateDate: | 03/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-21435 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.