Provider Demographics
NPI:1003370776
Name:SIMPSON, MIARA (LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:MIARA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 MCCUE RD APT 1811
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-7176
Mailing Address - Country:US
Mailing Address - Phone:832-908-1215
Mailing Address - Fax:
Practice Address - Street 1:7904 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7064
Practice Address - Country:US
Practice Address - Phone:713-355-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-18-34356103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst