Provider Demographics
NPI:1184495681
Name:BOUCHER, CINNAMON JOY (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:CINNAMON
Middle Name:JOY
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:CINNAMON
Other - Middle Name:JOY
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:2160 LAUREN CIR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-8500
Mailing Address - Country:US
Mailing Address - Phone:209-678-8559
Mailing Address - Fax:
Practice Address - Street 1:12110 HUFFMEISTER RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:281-894-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6531103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst