Provider Demographics
NPI:1790286789
Name:KHALEGHIPOUR, GRACE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:KHALEGHIPOUR
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 VIRGINIA PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5411
Mailing Address - Country:US
Mailing Address - Phone:469-284-0801
Mailing Address - Fax:903-630-6172
Practice Address - Street 1:5801 VIRGINIA PKWY STE 105
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5411
Practice Address - Country:US
Practice Address - Phone:214-729-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-24
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
TX388552355S0801X
TX4171103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant