Provider Demographics
NPI:1033882212
Name:YORDY, MATTHEW BRENDAN (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRENDAN
Last Name:YORDY
Suffix:
Gender:M
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SHELL DR
Mailing Address - Street 2:
Mailing Address - City:SHADY SHORES
Mailing Address - State:TX
Mailing Address - Zip Code:76208-7123
Mailing Address - Country:US
Mailing Address - Phone:214-457-6148
Mailing Address - Fax:
Practice Address - Street 1:2790 KELLER HICKS RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9610
Practice Address - Country:US
Practice Address - Phone:940-222-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-20-44396103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty