Provider Demographics
NPI:1942775804
Name:PACE, ROSALYN (RBT)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ROSALYN
Other - Middle Name:
Other - Last Name:WYCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:7A 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-5653
Mailing Address - Country:US
Mailing Address - Phone:210-276-1786
Mailing Address - Fax:
Practice Address - Street 1:7608 NARROW PASS ST
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3019
Practice Address - Country:US
Practice Address - Phone:210-714-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18-55823106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician