Provider Demographics
NPI:1912466749
Name:ESPINOSA, JANICE WONG (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:WONG
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HERMANN DR UNIT 1311
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7148
Mailing Address - Country:US
Mailing Address - Phone:281-725-1775
Mailing Address - Fax:
Practice Address - Street 1:18401 TIMBER FOREST DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2535
Practice Address - Country:US
Practice Address - Phone:281-852-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2676103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst