Provider Demographics
NPI:1023471950
Name:QUINTANILLA, JESSICA (MED, BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 BEE CAVES RD
Mailing Address - Street 2:SUITE B200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5588
Mailing Address - Country:US
Mailing Address - Phone:512-328-5599
Mailing Address - Fax:512-328-5585
Practice Address - Street 1:3006 BEE CAVES RD
Practice Address - Street 2:SUITE B200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5588
Practice Address - Country:US
Practice Address - Phone:512-328-5599
Practice Address - Fax:512-328-5585
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-21435103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst