Basic Information
| Provider Information | |||||||||
| NPI: | 1215409339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRIZALES | ||||||||
| FirstName: | SIMEI | ||||||||
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| Credential: | MS, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16800 DALLAS PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752481961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403007606 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 UNIVERSAL CITY BLVD | ||||||||
| Address2: | |||||||||
| City: | UNIVERSAL CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781483317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103361524 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2018 | ||||||||
| LastUpdateDate: | 12/31/2018 | ||||||||
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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 | 2624 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1-18-33487 | 01 | TX | BACB | OTHER |