Provider Demographics
NPI:1851010250
Name:SANCHEZ, MYA NICOLE
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:NICOLE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 HALLMARK DR W
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-3808
Mailing Address - Country:US
Mailing Address - Phone:817-883-5556
Mailing Address - Fax:
Practice Address - Street 1:4917 GOLDEN TRIANGLE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4480
Practice Address - Country:US
Practice Address - Phone:817-734-6515
Practice Address - Fax:817-734-8584
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst