Provider Demographics
NPI:1538649082
Name:CHURCH, VICTORIA (BCBA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CHURCH
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 1:12101 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2761
Mailing Address - Country:US
Mailing Address - Phone:281-894-1423
Mailing Address - Fax:
Practice Address - Street 1:12101 GRANT RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2761
Practice Address - Country:US
Practice Address - Phone:281-888-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-19-39213103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst