NPIMap

Organization Active NPI

North Texas Diagnostic Intervention Behavioral Clinic

  • Behavior Analyst
  • Wichita Falls, TX
National Provider Identifier
1902463276
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
NORTH TEXAS DIAGNOSTIC INTERVENTION BEHAVIORAL CLINIC
Practice address
3501 Sheppard Access Rd
Wichita Falls, TX 76306-4235
Phone
(940) 447-7115
NPI assigned
May 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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

Authorized official

Name
Rachel Samantha Bertelson, BCBA, LBA, LPA-I PHD
Title
Supervising Bcba, Lpa-I
Phone
(940) 386-2100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X

Addresses

Primary practice location

3501 Sheppard Access Rd
Wichita Falls, TX 76306-4235

Mailing address

3501 Sheppard Access Rd
Wichita Falls, TX 76306-4235
Phone (940) 867-7929

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619395200000",
    "number": "1902463276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 SHEPPARD ACCESS RD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763064235",
            "telephone_number": "940-867-7929",
            "fax_number": "940-386-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 SHEPPARD ACCESS RD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763064235",
            "telephone_number": "940-447-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH TEXAS DIAGNOSTIC INTERVENTION BEHAVIORAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-22",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A",
        "authorized_official_last_name": "BERTELSON",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "SAMANTHA",
        "authorized_official_title_or_position": "SUPERVISING BCBA, LPA-I",
        "authorized_official_telephone_number": "940-386-2100",
        "authorized_official_credential": "BCBA, LBA, LPA-I PHD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; 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.