Provider Demographics
NPI:1740887926
Name:ELLIOTT, DEVYN MAREE (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:DEVYN
Middle Name:MAREE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 FOREST CENTRAL DR STE 129
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3969
Mailing Address - Country:US
Mailing Address - Phone:214-802-4460
Mailing Address - Fax:
Practice Address - Street 1:11551 FOREST CENTRAL DR STE 129
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3969
Practice Address - Country:US
Practice Address - Phone:214-802-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician