MISS ADESUWA PHYLLIS IMADE (NPI# 1538633581) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538633581 |
| Entity Type | Individual |
| Full Name | MISS ADESUWA PHYLLIS IMADE |
| Practice Address |
1751 River Run # 200 Fort Worth TX 76107-6644 |
| Mailing Address |
21600 Oxnard St Woodland Hills CA 91367-4976 |
| Practice Telephone | 8183452345 |
| Mailing Telephone | 8183452345 |
| Enumeration Date | 2019-01-13 |
| Last Update Date | 2019-01-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers |
| Street Address |
1751 RIVER RUN # 200 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76107-6644 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316544547 | Olivia Shinall | Behavior Technician | 3036 Briery Dr, Fort Worth, TX 76119-1571 | 2020-10-01 |
| 1043823271 | Mink Sandhu | Behavior Technician | 4233 Silverwood Trl, Fort Worth, TX 76244-4959 | 2020-08-27 |
| 1053946830 | Jasmine Waheed | Behavior Technician | 2425 Half Moon Bay Ln, Fort Worth, TX 76177-3015 | 2020-03-11 |
| 1104468917 | Kylie Ann Montgomery | Behavior Technician | 12650 N Beach St Suite 146, Fort Worth, TX 76244 | 2019-10-14 |
| 1992347215 | Katherine M Wright | Behavior Technician | 5804 Boat Club Road, Fort Worth, TX 76179 | 2019-10-09 |
| 1982245775 | Makaylin Rene Mayes | Behavior Technician | 5804 Boat Club Rd, Fort Worth, TX 76179 | 2019-10-02 |
| 1760043319 | Kailey Davis | Behavior Technician | 1100 Circle Dr Ste 101, Fort Worth, TX 76119-8111 | 2019-06-25 |
| 1053876482 | Hannah Burgos | Behavior Technician | 4537 Heritage Trace Pkwy Bldg 11a, Fort Worth, TX 76244-8921 | 2019-02-11 |
| 1588185359 | Tamatha Weckwerth | Behavior Technician | 6133 Redear Dr, Fort Worth, TX 76179-7587 | 2017-07-03 |
| 1356874705 | Cymone Wisemon | Behavior Technician | 5200 Star Dr Apt 1617, Fort Worth, TX 76132-3321 | 2017-04-04 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76107 |
Please comment or provide details below to improve the information on MISS ADESUWA PHYLLIS IMADE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.