Provider Demographics
NPI:1740800622
Name:SALAS, ANGELINA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:SALAS
Suffix:
Gender:
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8640
Mailing Address - Country:US
Mailing Address - Phone:817-722-6118
Mailing Address - Fax:
Practice Address - Street 1:4140 MOLER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-6288
Practice Address - Country:US
Practice Address - Phone:214-336-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5767103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst