Provider Demographics
NPI:1689992141
Name:VENDITTI, TYRRELL ANN (MED, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:TYRRELL
Middle Name:ANN
Last Name:VENDITTI
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:TYRRELL
Other - Middle Name:ANN
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:1525 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4547
Mailing Address - Country:US
Mailing Address - Phone:832-769-9086
Mailing Address - Fax:
Practice Address - Street 1:507 AURORA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2329
Practice Address - Country:US
Practice Address - Phone:832-769-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-08
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-6469103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1783OtherSTATE LICENSED BEHAVIOR ANALYST
1-09-6469OtherBACB