Individual
MYRA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5400 W PLANO PKWY STE 200, PLANO, TX 75093-4855
(972) 665-7251
Mailing address
18726 S WESTERN AVE STE 408, GARDENA, CA 90248-3858
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
4639
TX
106S00000X
Behavior Technician
00010707
TX
Other
Enumeration date
12/15/2020
Last updated
01/12/2022
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