Provider Demographics
NPI:1821500471
Name:MINEAR, REAGAN DANIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:DANIELLE
Last Name:MINEAR
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 1:5843 CLEARWATER CT
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3868
Mailing Address - Country:US
Mailing Address - Phone:832-654-4489
Mailing Address - Fax:
Practice Address - Street 1:8400 STACY RD STE 300
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2144
Practice Address - Country:US
Practice Address - Phone:832-654-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX1-18-33675103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician