Provider Demographics
NPI:1770074916
Name:GODINA MUNOZ, MISAEL ANTONIO
Entity type:Individual
Prefix:MR
First Name:MISAEL
Middle Name:ANTONIO
Last Name:GODINA MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10503 METRIC DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5514
Mailing Address - Country:US
Mailing Address - Phone:972-644-2076
Mailing Address - Fax:
Practice Address - Street 1:10503 METRIC DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5514
Practice Address - Country:US
Practice Address - Phone:972-644-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-16-11899106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician