Provider Demographics
NPI:1063390524
Name:FRAZIER, CHARLA GAYLEAN (BCBA)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:GAYLEAN
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CHARLA
Other - Middle Name:GAYLEAN
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHARLA CHIVIS
Mailing Address - Street 1:3022 GRAYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-1457
Mailing Address - Country:US
Mailing Address - Phone:832-928-7388
Mailing Address - Fax:
Practice Address - Street 1:3022 GRAYSTONE CT
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-1457
Practice Address - Country:US
Practice Address - Phone:832-928-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-23
Last Update Date:2025-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-25-82953103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst