Healthcare Provider Details

I. General information

NPI: 1386231694
Provider Name (Legal Business Name): MAYA KRISTINA CUELLAR BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 W SPRING CREEK PKWY
PLANO TX
75024-5283
US

IV. Provider business mailing address

2709 CRYSTAL FALLS DR
GARLAND TX
75044-2847
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-0035
  • Fax:
Mailing address:
  • Phone: 214-493-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3786
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: