Provider Demographics
NPI:1881413466
Name:KHAN, MOHAMMAD BILAL (RBT)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:BILAL
Last Name:KHAN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1155
Mailing Address - Country:US
Mailing Address - Phone:469-630-1838
Mailing Address - Fax:
Practice Address - Street 1:1700 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-1155
Practice Address - Country:US
Practice Address - Phone:469-630-1838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-279620106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician