Provider Demographics
NPI:1568059517
Name:SUTTON, AJISHA MONIQUE (BCABA)
Entity Type:Individual
Prefix:
First Name:AJISHA
Middle Name:MONIQUE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 MAGIC DR APT 1014
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2964
Mailing Address - Country:US
Mailing Address - Phone:210-396-9654
Mailing Address - Fax:
Practice Address - Street 1:11006 RIVER STROLL ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2524
Practice Address - Country:US
Practice Address - Phone:855-374-4900
Practice Address - Fax:855-322-3694
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-22-13959106E00000X
TX247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other