Provider Demographics
NPI:1912516238
Name:PROCTER, SANDRA MARIE (RBT, LABA (NV) BCABA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:PROCTER
Suffix:
Gender:F
Credentials:RBT, LABA (NV) BCABA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1850 IDLEWILD DR APT D1
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1025
Mailing Address - Country:US
Mailing Address - Phone:559-906-2232
Mailing Address - Fax:
Practice Address - Street 1:10574 MOSS WOOD CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4148
Practice Address - Country:US
Practice Address - Phone:775-843-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLABA430106E00000X
NVRBT1447106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician