Provider Demographics
NPI:1447751938
Name:WASHINGTON, MYLENI GONZALES (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MYLENI
Middle Name:GONZALES
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 KARCIO CT
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5533
Mailing Address - Country:US
Mailing Address - Phone:408-528-5331
Mailing Address - Fax:
Practice Address - Street 1:904 W RIVERSIDE AVE # 1137
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1011
Practice Address - Country:US
Practice Address - Phone:510-910-4449
Practice Address - Fax:510-631-0163
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WA1-23-64333103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician