Individual provider · NPI-1
Molly Gamboa, BCBA
Behavior Analyst · Addison, TX
NPI number1013552066
StatusActive
Last updated in NPPESNov 14, 2019
Details
- NPI
- 1013552066
- Entity type
- Individual (NPI-1)
- Name
- Molly Gamboa
- Credential
- BCBA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 14, 2019
- Last updated
- Nov 14, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103K00000X | Behavior Analyst | – | – | Yes |
Practice location
14675 Midway RdAddison, TX 75001-3170
Phone 903-630-7077
Mailing address
120 E South Town DrTyler, TX 75703-4747
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