Provider Demographics
NPI:1285392241
Name:CANALES, CHRYSTIN NICOLE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:CHRYSTIN
Middle Name:NICOLE
Last Name:CANALES
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S INTERSTATE 35 E APT 4102
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6921
Mailing Address - Country:US
Mailing Address - Phone:361-389-1498
Mailing Address - Fax:
Practice Address - Street 1:2612 LONG PRAIRIE RD STE B
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4981
Practice Address - Country:US
Practice Address - Phone:855-782-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-61670106S00000X
TX1-22-59220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician