Provider Demographics
NPI:1982478855
Name:BANGURA, ABU BAKARR
Entity Type:Individual
Prefix:
First Name:ABU
Middle Name:BAKARR
Last Name:BANGURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6031 PINELAND DR APT 2309
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5467
Mailing Address - Country:US
Mailing Address - Phone:469-648-6970
Mailing Address - Fax:
Practice Address - Street 1:400 E ROYAL LN BLDG 3
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3540
Practice Address - Country:US
Practice Address - Phone:469-249-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst