Individual
DEVIN SISOMPHOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA, M.ED, LBA
Contact information
Practice address
6102 82ND ST STE 10, LUBBOCK, TX 79424
(806) 993-3333
Mailing address
3100 PREMIER DR STE 234, IRVING, TX 75063-2693
(806) 993-3333
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
3032
TX
247200000X
Other Technician
RBT-17-33360
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3032
TEXAS DEPARTMENT OF LICENSING & REGULATION
TX
01
—
RBT-17-33360
BACB
TX
Enumeration date
07/31/2018
Last updated
10/03/2019
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