Healthcare Provider Details

I. General information

NPI: 1447751938
Provider Name (Legal Business Name): MYLENI GONZALES WASHINGTON BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 W RIVERSIDE AVE # 1137
SPOKANE WA
99201-1011
US

IV. Provider business mailing address

550 KARCIO CT
PULLMAN WA
99163-5533
US

V. Phone/Fax

Practice location:
  • Phone: 510-910-4449
  • Fax: 510-631-0163
Mailing address:
  • Phone: 408-528-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-64333
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: