Provider Demographics
NPI:1245683119
Name:MURA, RANDI M (BCBA)
Entity type:Individual
Prefix:MISS
First Name:RANDI
Middle Name:M
Last Name:MURA
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 1:201 RIVER POINTE DR APT 117
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2894
Mailing Address - Country:US
Mailing Address - Phone:504-444-2092
Mailing Address - Fax:
Practice Address - Street 1:201 RIVER POINTE DR APT 117
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2894
Practice Address - Country:US
Practice Address - Phone:504-444-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-22328103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst