Provider Demographics
NPI:1609481431
Name:DOBRY-MENDOZA, TIFFANY (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DOBRY-MENDOZA
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:DOBRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD STE K2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8600
Mailing Address - Country:US
Mailing Address - Phone:512-200-2972
Mailing Address - Fax:
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD STE K2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8600
Practice Address - Country:US
Practice Address - Phone:512-200-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20-134572106S00000X
1-25-79069103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8061OtherTEXAS LICENSURE BOARD
1-25-79069OtherBACB
1-25-79609OtherBACB