Provider Demographics
NPI:1912226283
Name:ANGLIN, DERRIC JR (BCBA)
Entity Type:Individual
Prefix:
First Name:DERRIC
Middle Name:
Last Name:ANGLIN
Suffix:JR
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 1:5922 NICKEL BEND LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2460
Mailing Address - Country:US
Mailing Address - Phone:909-571-8321
Mailing Address - Fax:909-222-6817
Practice Address - Street 1:5922 NICKEL BEND LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2460
Practice Address - Country:US
Practice Address - Phone:909-571-8321
Practice Address - Fax:909-222-6817
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-14-9984103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst