Provider Demographics
NPI:1730754227
Name:BLANCO, AGUSTINA (RBT)
Entity type:Individual
Prefix:MRS
First Name:AGUSTINA
Middle Name:
Last Name:BLANCO
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 1:10700 RICHMOND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4905
Mailing Address - Country:US
Mailing Address - Phone:832-470-8010
Mailing Address - Fax:
Practice Address - Street 1:10700 RICHMOND AVE STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4905
Practice Address - Country:US
Practice Address - Phone:832-470-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-165520106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician