Provider Demographics
NPI:1205581915
Name:SANTIBANEZ-TANON, GINAIRIS (BCBA)
Entity type:Individual
Prefix:
First Name:GINAIRIS
Middle Name:
Last Name:SANTIBANEZ-TANON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 POST OAK BLVD APT 352
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3112
Mailing Address - Country:US
Mailing Address - Phone:414-722-8995
Mailing Address - Fax:
Practice Address - Street 1:10777 WESTHEIMER RD STE 1100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3462
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-22-58088103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst