Provider Demographics
NPI:1902671795
Name:ONEAL, JARDIN ELLETTA (RBT)
Entity Type:Individual
Prefix:
First Name:JARDIN
Middle Name:ELLETTA
Last Name:ONEAL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JARDIN
Other - Middle Name:ELLETTA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3101 VISTA DR APT 4113
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2382
Mailing Address - Country:US
Mailing Address - Phone:346-479-2974
Mailing Address - Fax:
Practice Address - Street 1:3101 VISTA DR APT 4113
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2382
Practice Address - Country:US
Practice Address - Phone:346-479-2974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB694346106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician