Provider Demographics
NPI:1558051185
Name:GUARIN, LEIDY TATIANA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LEIDY
Middle Name:TATIANA
Last Name:GUARIN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HICKORY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-7842
Mailing Address - Country:US
Mailing Address - Phone:469-939-0733
Mailing Address - Fax:
Practice Address - Street 1:2720 W EULESS BLVD
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-6616
Practice Address - Country:US
Practice Address - Phone:817-562-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst