Provider Demographics
NPI:1912589904
Name:BABINEAUX, ANJELICIA L
Entity Type:Individual
Prefix:
First Name:ANJELICIA
Middle Name:L
Last Name:BABINEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANJELICIA
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4407 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-2745
Mailing Address - Country:US
Mailing Address - Phone:817-734-8151
Mailing Address - Fax:
Practice Address - Street 1:6513 PRECINCT LINE RD # 150
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-4313
Practice Address - Country:US
Practice Address - Phone:682-257-3531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician