Provider Demographics
NPI:1457650434
Name:GOMEZ, GRACIELA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 FORD RD
Mailing Address - Street 2:SUITE 189
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7244
Mailing Address - Country:US
Mailing Address - Phone:888-922-2843
Mailing Address - Fax:310-324-3134
Practice Address - Street 1:12200 FORD RD
Practice Address - Street 2:SUITE 189
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7244
Practice Address - Country:US
Practice Address - Phone:888-922-2843
Practice Address - Fax:310-324-3134
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst