Individual provider Active NPI

Kassandra Bustos, BCBA LBA

  • Behavior Analyst
  • Round Rock, TX
National Provider Identifier
1366123341
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
6023 Issued in TX
Practice address
15930 S Great Oaks Dr
Round Rock, TX 78681-5800
Phone
(512) 460-1950
NPI assigned
Jul 31, 2023
Last updated
Jul 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 6023 TX Primary

Addresses

Primary practice location

15930 S Great Oaks Dr
Round Rock, TX 78681-5800

Mailing address

12408 Dessau Rd Apt 1108
Austin, TX 78754-2239
Phone (956) 789-5600

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

LicenseStateTypeSpecialty
6023TXMDBehavioral Analyst

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1366123341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12408 DESSAU RD APT 1108",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787542239",
            "telephone_number": "956-789-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15930 S GREAT OAKS DR",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786815800",
            "telephone_number": "512-460-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTOS",
        "first_name": "KASSANDRA",
        "credential": "BCBA LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "6023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Round Rock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.