Provider Demographics
NPI:1205336633
Name:BRAFFORD, TASIA LORISSA (BCBA)
Entity type:Individual
Prefix:
First Name:TASIA
Middle Name:LORISSA
Last Name:BRAFFORD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TASIA
Other - Middle Name:LORISSA
Other - Last Name:CORBARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1727 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1904
Mailing Address - Country:US
Mailing Address - Phone:817-412-8947
Mailing Address - Fax:
Practice Address - Street 1:1727 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1904
Practice Address - Country:US
Practice Address - Phone:817-412-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-25146103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst