Provider Demographics
NPI:1609310150
Name:MASSEY, RACHEL (BCBA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MASSEY
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 1:3310 S BROADWAY AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7851
Mailing Address - Country:US
Mailing Address - Phone:210-504-6277
Mailing Address - Fax:903-470-7327
Practice Address - Street 1:3310 S BROADWAY AVE STE 100A
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7851
Practice Address - Country:US
Practice Address - Phone:210-504-6277
Practice Address - Fax:903-470-7327
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBCBA-16-8627-044596103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst