Ebony Tyiann Marie Conner
Individual provider Active NPI Behavior Technician · Abq, NM
NPI 1215752886 · NPPES record last updated Nov 19, 2024
Key facts
- NPI
- 1215752886
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 4600 Columbine Ave NE
Abq, NM 87008 - Phone
- (505) 916-7618
- NPI assigned
- Nov 19, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | NM | Yes |
Addresses
Primary practice location
4600 Columbine Ave NE
Abq, NM 87008
Mailing address
4600 Columbine Ave NE
Albuquerque, NM 87113-2236
Phone (505) 916-7618
Other providers in Abq, NM
- Dulce Cervantes Montalvo
- Maria C Chavez
- Debra Jane Eastman
- Tracey J Folland
- Wendy Lee Hopkins
- Laura Tenorio
All providers in Abq, NM · Behavior Technician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.