Provider Demographics
NPI:1194091058
Name:MARION, SAMANTHA (BCBA)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:
Last Name:MARION
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 1:9901 N CAPITAL OF TEXAS HWY
Mailing Address - Street 2:#250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5852
Mailing Address - Country:US
Mailing Address - Phone:512-887-2126
Mailing Address - Fax:
Practice Address - Street 1:9901 N CAPITAL OF TEXAS HWY
Practice Address - Street 2:#250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5852
Practice Address - Country:US
Practice Address - Phone:512-887-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-10123103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-12-10123OtherBCBA