Provider Demographics
NPI:1891341848
Name:COSTELLO, ERIN THERESE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:THERESE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 LA FRONTERA BLVD APT 2127
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-8047
Mailing Address - Country:US
Mailing Address - Phone:517-927-1713
Mailing Address - Fax:
Practice Address - Street 1:2801 OAKMONT DR STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1021
Practice Address - Country:US
Practice Address - Phone:512-354-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2886103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst