Provider Demographics
NPI:1508500604
Name:FONSECA, HALLIE RACHEL (RBT)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:RACHEL
Last Name:FONSECA
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 1:9901 N CAPITAL OF TEXAS HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5977
Mailing Address - Country:US
Mailing Address - Phone:512-887-2126
Mailing Address - Fax:
Practice Address - Street 1:9901 N CAPITAL OF TEXAS HWY STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5977
Practice Address - Country:US
Practice Address - Phone:512-887-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-22-212912OtherBACB CERTIFICATION NUMBER