Provider Demographics
NPI:1831595420
Name:SEAGO, MATTHEW LEON (BCBA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LEON
Last Name:SEAGO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 SONESTA DR APT B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2768
Mailing Address - Country:US
Mailing Address - Phone:904-540-8730
Mailing Address - Fax:
Practice Address - Street 1:427 E DURANTA AVE STE 110
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-3409
Practice Address - Country:US
Practice Address - Phone:512-898-9044
Practice Address - Fax:512-857-1423
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1119679103K00000X
TX1846103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst