Provider Demographics
NPI:1306341177
Name:LONGORIA, MIRIAM (BCBA)
Entity type:Individual
Prefix:MISS
First Name:MIRIAM
Middle Name:
Last Name:LONGORIA
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 1:620 N ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5312
Mailing Address - Country:US
Mailing Address - Phone:254-732-2262
Mailing Address - Fax:
Practice Address - Street 1:620 N ROBINSON DR
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:TX
Practice Address - Zip Code:76706-5312
Practice Address - Country:US
Practice Address - Phone:254-732-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty