Provider Demographics
NPI:1154076016
Name:RESTREPO, LAURA CRISTINA (RBT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CRISTINA
Last Name:RESTREPO
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 1:15103 MASON RD STE C-1
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6755
Mailing Address - Country:US
Mailing Address - Phone:832-653-4369
Mailing Address - Fax:
Practice Address - Street 1:15103 MASON RD STE C-1
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6755
Practice Address - Country:US
Practice Address - Phone:832-653-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-202315106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-22-202315OtherBEHAVIOR ANALYST CERTIFICATION BOARD