Provider Demographics
NPI:1174290803
Name:SPURGIN, DESTINY RACHELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:RACHELLE
Last Name:SPURGIN
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 1:11551 FOREST CENTRAL DR STE 129
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3920
Mailing Address - Country:US
Mailing Address - Phone:469-573-4492
Mailing Address - Fax:214-583-2361
Practice Address - Street 1:11551 FOREST CENTRAL DR STE 129
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3920
Practice Address - Country:US
Practice Address - Phone:469-573-4492
Practice Address - Fax:214-583-2361
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4209103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst