Provider Demographics
NPI:1750952743
Name:JAMES, BECKY LYN
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:LYN
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-4259
Mailing Address - Country:US
Mailing Address - Phone:830-613-9194
Mailing Address - Fax:
Practice Address - Street 1:19019 HWY 71 W
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6468
Practice Address - Country:US
Practice Address - Phone:512-646-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-17-45340106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty