Provider Demographics
NPI:1124513643
Name:DUBROCQ, ALANA (BCBA)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:DUBROCQ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S MAIN ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3462
Mailing Address - Country:US
Mailing Address - Phone:240-614-1201
Mailing Address - Fax:
Practice Address - Street 1:520 S MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3462
Practice Address - Country:US
Practice Address - Phone:240-614-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-20-43211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician