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General NPI Number Information
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NPI Number | 1821682170
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Entity Type | Individual
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Provider Name | MARI-LUCI CERDA BCBA, LBA-TX
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Gender | Female
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 5502 58TH ST STE 500
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City | LUBBOCK
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State | TX
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Zip | 79414-2087
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Country | US
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Telephone | 806-703-4379
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Fax |
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Provider Business Mailing Address
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Address Line | 2824 25TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-2216
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Country | US
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Telephone | 979-323-4352
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 3087
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 11937973
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License Number State | TX
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