Healthcare Provider Details

I. General information

NPI: 1912516238
Provider Name (Legal Business Name): SANDRA MARIE PROCTER BCBA (BACB608548)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA MARIE LONG

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 IDLEWILD DR APT D1
RENO NV
89509-1025
US

IV. Provider business mailing address

1850 IDLEWILD DR APT D1
RENO NV
89509-1025
US

V. Phone/Fax

Practice location:
  • Phone: 559-906-2232
  • Fax:
Mailing address:
  • Phone: 559-906-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0952
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: