Provider Demographics
NPI:1114428687
Name:REVELEY, MONICA MARIA (RBT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIA
Last Name:REVELEY
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 1:7700 N CAPITAL OF TEXAS HWY APT 1325
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1177
Mailing Address - Country:US
Mailing Address - Phone:210-315-9713
Mailing Address - Fax:
Practice Address - Street 1:2105 E PARK ST
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4598
Practice Address - Country:US
Practice Address - Phone:512-588-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-16-15316106S00000X
TX2541103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2541OtherLICENSED BEHAVIOR ANALYST
TX1-18-31432OtherBOARD CERTIFIED BEHAVIOR ANALYST