Healthcare Provider Details

I. General information

NPI: 1720943988
Provider Name (Legal Business Name): JACKLYN BELLEW BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACKLYN BABOR BCBA

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 MEDICAL DR STE 1200
ALLEN TX
75013-5756
US

IV. Provider business mailing address

919 MEDICAL DR STE 1200
ALLEN TX
75013-5756
US

V. Phone/Fax

Practice location:
  • Phone: 972-217-4110
  • Fax:
Mailing address:
  • Phone: 972-217-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86601
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: