Provider Demographics
NPI:1427445303
Name:BOURN, CRISTAL (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:CRISTAL
Middle Name:
Last Name:BOURN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1521
Mailing Address - Country:US
Mailing Address - Phone:330-606-9763
Mailing Address - Fax:
Practice Address - Street 1:2668 N HAVEN BLVD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2742
Practice Address - Country:US
Practice Address - Phone:330-606-9763
Practice Address - Fax:330-470-3424
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-18
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst