Provider Demographics
NPI:1083120018
Name:TERRONES, ANGELICA M (RBT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:M
Last Name:TERRONES
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 1:5941 SANTANA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7640
Mailing Address - Country:US
Mailing Address - Phone:719-232-3498
Mailing Address - Fax:
Practice Address - Street 1:5941 SANTANA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-7640
Practice Address - Country:US
Practice Address - Phone:719-232-3498
Practice Address - Fax:719-232-3498
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17-34257106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
17-34257OtherRBT