Provider Demographics
NPI:1386207058
Name:CONBOY, CRISTA (BCBA)
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:
Last Name:CONBOY
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 1:11341 W COLLINA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-6238
Mailing Address - Country:US
Mailing Address - Phone:415-212-8596
Mailing Address - Fax:
Practice Address - Street 1:11341 W COLLINA VISTA DR
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-6238
Practice Address - Country:US
Practice Address - Phone:415-212-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-27526OtherBACB