Provider Demographics
NPI:1265776850
Name:WOOTEN, JILL ANJANETTE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANJANETTE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6301 CAMPUS CIRCLE DR E STE 100A
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2705
Mailing Address - Country:US
Mailing Address - Phone:469-374-0700
Mailing Address - Fax:469-374-0800
Practice Address - Street 1:6301 CAMPUS CIRCLE DR E STE 100A
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2705
Practice Address - Country:US
Practice Address - Phone:469-374-0700
Practice Address - Fax:469-374-0800
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-08-4085103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst