Provider Demographics
NPI:1780262493
Name:GAVILLA, BRENDA LI (BCBA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LI
Last Name:GAVILLA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 OLD FREDERICKSBURG RD # 90851
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1216
Mailing Address - Country:US
Mailing Address - Phone:512-423-4467
Mailing Address - Fax:
Practice Address - Street 1:5307 W HIGHWAY 290 BLDG B-11
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8965
Practice Address - Country:US
Practice Address - Phone:512-423-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12808106E00000X
TXRBT-20-118471106S00000X
TX5952103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician