Active NPI
Ivette Vital
- Behavior Technician
- Desoto, TX
National Provider Identifier
1073492146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB1229425
- Practice address
- 1501 N Hampton Rd
Desoto, TX 75115-2301 - Phone
- (469) 659-7216
- NPI assigned
- Sep 2, 2025
- Last updated
- Sep 2, 2025
- Sex
- Female
- 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 | BACB1229425 | TX | Primary |
Addresses
Primary practice location
1501 N Hampton Rd
Desoto, TX 75115-2301
Mailing address
14801 Magnolia LN
Balch Springs, TX 75180-4353
Phone (469) 662-1815
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 |
|---|---|---|---|
| BACB1229425 | TX | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756771200000",
"number": "1073492146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14801 MAGNOLIA LN",
"city": "BALCH SPRINGS",
"state": "TX",
"postal_code": "751804353",
"telephone_number": "469-662-1815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 N HAMPTON RD",
"city": "DESOTO",
"state": "TX",
"postal_code": "751152301",
"telephone_number": "469-659-7216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VITAL",
"first_name": "IVETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-02",
"last_updated": "2025-09-02",
"certification_date": "2025-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "TX",
"license": "BACB1229425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Desoto, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.