Provider Demographics
NPI:1295215382
Name:REYNA, SUZETTE NICHOLE (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:SUZETTE
Middle Name:NICHOLE
Last Name:REYNA
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 1:7108 N 23RD ST STE B2
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6506
Mailing Address - Country:US
Mailing Address - Phone:956-627-4413
Mailing Address - Fax:956-627-5312
Practice Address - Street 1:7108 N 23RD ST STE B2
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6506
Practice Address - Country:US
Practice Address - Phone:956-627-4413
Practice Address - Fax:956-627-5312
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390452355S0801X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant