Provider Demographics
NPI:1487209771
Name:TANG, GENIVEVE (BCBA)
Entity Type:Individual
Prefix:
First Name:GENIVEVE
Middle Name:
Last Name:TANG
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 1:6105 WINDCOM CT STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-9003
Mailing Address - Country:US
Mailing Address - Phone:972-312-8733
Mailing Address - Fax:972-378-4747
Practice Address - Street 1:500 DISCOVERY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8637
Practice Address - Country:US
Practice Address - Phone:720-647-8541
Practice Address - Fax:972-378-4747
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CO1-20-44410103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician