Provider Demographics
NPI:1063863462
Name:MOLINA, JACQUELINE RAE (BCBA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RAE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9641 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2950
Mailing Address - Country:US
Mailing Address - Phone:512-820-3046
Mailing Address - Fax:
Practice Address - Street 1:5901 OLD FREDERICKSBURG RD
Practice Address - Street 2:D101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1209
Practice Address - Country:US
Practice Address - Phone:512-898-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-22785103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst