Provider Demographics
NPI:1972266419
Name:MARTIN, CHESLEY ANNE (RBT)
Entity Type:Individual
Prefix:
First Name:CHESLEY
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 N COLLINS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-4557
Mailing Address - Country:US
Mailing Address - Phone:817-533-7081
Mailing Address - Fax:
Practice Address - Street 1:4140 N COLLINS ST STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-4557
Practice Address - Country:US
Practice Address - Phone:817-533-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB719579106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician