Provider Demographics
NPI:1083297584
Name:CLEMONS, VONKEYCHA (RBT)
Entity Type:Individual
Prefix:
First Name:VONKEYCHA
Middle Name:
Last Name:CLEMONS
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 1:3604 S W S YOUNG DR APT 733
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2954
Mailing Address - Country:US
Mailing Address - Phone:254-278-1427
Mailing Address - Fax:
Practice Address - Street 1:3604 S W S YOUNG DR APT 733
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2954
Practice Address - Country:US
Practice Address - Phone:254-278-1427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-21-166347106S00000X
TXRBT-23-296294106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician