Provider Demographics
NPI:1093216673
Name:PETRE, ERIKA AMETHYST (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:AMETHYST
Last Name:PETRE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 JAIRED DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-4416
Mailing Address - Country:US
Mailing Address - Phone:210-748-4432
Mailing Address - Fax:
Practice Address - Street 1:1250 S A W GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2854
Practice Address - Country:US
Practice Address - Phone:512-677-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician