MEDICARE: DEMI DARR BCBA, MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	7976	TX

General Provider Information

NPI Number	:	1306474705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMI DARR BCBA, MA

Provider Business Mailing Address
First Line	:	6555 OLD JACKSONVILLE HWY STE 140
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-0720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6555 OLD JACKSONVILLE HWY STE 140
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-0720
Country	:	US
Telephone Number	:	903-781-0284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	01/23/2025

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