MEDICARE: SALLY T TRAN MA, BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	1-22-57763

General Provider Information

NPI Number	:	1639737505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY T TRAN MA, BCBA, LBA

Provider Business Mailing Address
First Line	:	8811 SIENNA SPRINGS BLVD APT 1423
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-7334
Country	:	US
Telephone Number	:	224-800-4072
Fax Number	:

Provider Business Practice Location Address
First Line	:	8570 SIENNA SPRINGS BLVD STE A
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459
Country	:	US
Telephone Number	:	346-450-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	05/17/2022

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