Provider Demographics
NPI:1003365479
Name:SCALLAN, CAMERON MONTGOMERY (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:MONTGOMERY
Last Name:SCALLAN
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13604 MIDWAY RD
Mailing Address - Street 2:SKILL SPROUT
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13604 MIDWAY RD
Practice Address - Street 2:SKILL SPROUT
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-4305
Practice Address - Country:US
Practice Address - Phone:469-265-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst