Provider Demographics
NPI:1386169399
Name:MANELL, TARA (BCBA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MANELL
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:PETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7500 SAN FELIPE ST STE 990
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2601 N WALTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4337
Practice Address - Country:US
Practice Address - Phone:479-802-4798
Practice Address - Fax:479-668-0589
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-19-37303103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician