Healthcare Provider Details

I. General information

NPI: 1720120215
Provider Name (Legal Business Name): TYNETTE CHANG BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TYNETTE SOLOMON

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

IV. Provider business mailing address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5977
  • Fax:
Mailing address:
  • Phone: 888-344-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB11725713
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: