Provider Demographics
NPI:1184246316
Name:COULTER, MIRIAM SARAHI (MA, RBT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:SARAHI
Last Name:COULTER
Suffix:
Gender:F
Credentials:MA, RBT
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:SARAHI
Other - Last Name:IZAGUIRRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, RBT
Mailing Address - Street 1:15911 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15911 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1107
Practice Address - Country:US
Practice Address - Phone:210-599-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-16-18774106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician