Provider Demographics
NPI:1730957051
Name:PEREZ, BERNADETTE (RBT)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:PEREZ
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 1:310 W CENTRAL EXPRESSWAY SUIT 1
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-3713
Mailing Address - Country:US
Mailing Address - Phone:254-432-7041
Mailing Address - Fax:
Practice Address - Street 1:310 W CENTRAL EXPRESSWAY SUIT 1
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-3713
Practice Address - Country:US
Practice Address - Phone:254-432-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23302124106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty