Provider Demographics
NPI:1174142228
Name:RIOJAS, MACKYNNA REAGAN (RBT)
Entity type:Individual
Prefix:MRS
First Name:MACKYNNA
Middle Name:REAGAN
Last Name:RIOJAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 W HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6392
Mailing Address - Country:US
Mailing Address - Phone:325-949-6250
Mailing Address - Fax:
Practice Address - Street 1:439 W HARRIS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6392
Practice Address - Country:US
Practice Address - Phone:325-949-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-115622106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician