Provider Demographics
NPI:1811490568
Name:PERANICH, JUSTINE MONET (BCBA)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MONET
Last Name:PERANICH
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 1:1308 DART ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-6206
Mailing Address - Country:US
Mailing Address - Phone:281-773-1048
Mailing Address - Fax:
Practice Address - Street 1:730 PEACHTREE ST NE STE 570
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1244
Practice Address - Country:US
Practice Address - Phone:404-551-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4670103K00000X
TX0-17-7864106E00000X
TX1-21-56270103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst