Provider Demographics
NPI:1609332048
Name:MENDOZA, VANESSA (BCBA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MENDOZA
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 1:1405 MARIANO PLZ
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-4251
Mailing Address - Country:US
Mailing Address - Phone:214-673-0760
Mailing Address - Fax:
Practice Address - Street 1:900 JUNCTION DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5290
Practice Address - Country:US
Practice Address - Phone:469-675-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-16-25615247200000X
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-16-25615OtherBACB