Provider Demographics
NPI:1821646563
Name:BUSOUL, RAINA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:BUSOUL
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 RIVER RUN STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6670
Mailing Address - Country:US
Mailing Address - Phone:817-866-7627
Mailing Address - Fax:817-886-7662
Practice Address - Street 1:1751 RIVER RUN STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6670
Practice Address - Country:US
Practice Address - Phone:817-866-7627
Practice Address - Fax:817-886-7662
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX3173103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician