Provider Demographics
NPI:1013505924
Name:DERRICK, GRETCHEN QUINN (MA, BCBA, TX)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:QUINN
Last Name:DERRICK
Suffix:
Gender:F
Credentials:MA, BCBA, TX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 VASCO WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1710
Mailing Address - Country:US
Mailing Address - Phone:915-799-7234
Mailing Address - Fax:
Practice Address - Street 1:7470 CIMARRON PLZ STE 200
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-2220
Practice Address - Country:US
Practice Address - Phone:915-975-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB623624106S00000X
TX7560103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician