Active NPI
Blake Odus Connell, RBT
- Behavior Technician
- San Antonio, TX
National Provider Identifier
1053129114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 24-386636
- Practice address
- 12175 Network Blvd
San Antonio, TX 78249-3413 - Phone
- (210) 797-7181
- NPI assigned
- Dec 20, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 24-386636 | CO | Primary |
Addresses
Primary practice location
12175 Network Blvd
San Antonio, TX 78249-3413
Mailing address
100 N Santa Rosa Apt 927
San Antonio, TX 78207-3269
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24-386636 | CO | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Twinkle Autism Therapy, LLC | Behavior Technician | Current | Accepting new patients |
| Twinkle Autism Therapy, LLC | Behavior Technician | Current | Accepting new patients |
Locations
12175 Network Blvd
San Antonio, TX 78249
Phone (210) 797-7181
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734652800000",
"number": "1053129114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N SANTA ROSA APT 927",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782073269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12175 NETWORK BLVD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782493413",
"telephone_number": "210-797-7181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELL",
"first_name": "BLAKE",
"middle_name": "ODUS",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-12-20",
"last_updated": "2024-12-20",
"certification_date": "2024-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CO",
"license": "24-386636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.