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Individual

CRYSTAL LEIGH TUNGKANAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCABA

Contact information

Practice address
8720 MAIN ST, FRISCO, TX 75033-3079
(469) 803-5655
Mailing address
8601 WAGON TRL, CROSSROADS, TX 76227-2217
(757) 593-2568

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0-19-10228
BACB
Enumeration date
10/10/2019
Last updated
10/10/2019
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