Provider Demographics
NPI:1518631068
Name:COLVILLE, MARGARET MACKENZIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MACKENZIE
Last Name:COLVILLE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12650 N BEACH ST STE 146
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4253
Mailing Address - Country:US
Mailing Address - Phone:817-249-8100
Mailing Address - Fax:
Practice Address - Street 1:12650 N BEACH ST STE 146
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4253
Practice Address - Country:US
Practice Address - Phone:972-850-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX1-23-68643103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician