Provider Demographics
NPI:1659150431
Name:BEGELTON, DOMINIQUE ZANAYVIA
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:ZANAYVIA
Last Name:BEGELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16378 PAITER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-4420
Mailing Address - Country:US
Mailing Address - Phone:832-291-7771
Mailing Address - Fax:
Practice Address - Street 1:12246 QUEENSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5354
Practice Address - Country:US
Practice Address - Phone:832-291-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-298439106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician