Provider Demographics
NPI:1447086855
Name:LUCERO, CHANTEL (BCBA)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:LUCERO
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 1:900 W ST HWY 6
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3775
Mailing Address - Country:US
Mailing Address - Phone:254-300-5090
Mailing Address - Fax:866-790-8027
Practice Address - Street 1:900 W ST HWY 6
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3775
Practice Address - Country:US
Practice Address - Phone:254-300-5090
Practice Address - Fax:866-790-8027
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23-284500106S00000X
TX1-24-78682103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician