Provider Demographics
NPI:1821591140
Name:BELK, MIRANDA RENE' (BCBA)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:RENE'
Last Name:BELK
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 1:7000 NW 100 DR STE B100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-2051
Mailing Address - Country:US
Mailing Address - Phone:713-462-6060
Mailing Address - Fax:866-849-5747
Practice Address - Street 1:7000 NW 100 DR STE B100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-2051
Practice Address - Country:US
Practice Address - Phone:713-462-6060
Practice Address - Fax:866-849-5747
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-29109103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst