Provider Demographics
NPI:1568166155
Name:ANAYA, ANDREA (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ANAYA
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14130 MILLGLEN CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2298
Mailing Address - Country:US
Mailing Address - Phone:832-929-8968
Mailing Address - Fax:
Practice Address - Street 1:14130 MILLGLEN CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2298
Practice Address - Country:US
Practice Address - Phone:832-929-8968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5712103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst