Provider Demographics
NPI:1477126423
Name:CHAMPION, DESMON MARQUE (RBT)
Entity Type:Individual
Prefix:
First Name:DESMON
Middle Name:MARQUE
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4105 W SPRING CREEK PKWY
Mailing Address - Street 2:STE 602/614
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:972-596-0035
Mailing Address - Fax:972-596-8080
Practice Address - Street 1:4105 W SPRING CREEK PKWY
Practice Address - Street 2:STE 602/614
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-596-0035
Practice Address - Fax:972-596-8080
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician