Provider Demographics
NPI:1295122240
Name:LIN, FANG YU (BCBA)
Entity type:Individual
Prefix:
First Name:FANG YU
Middle Name:
Last Name:LIN
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 1:7122 WOOD HOLLOW DR APT 3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2544
Mailing Address - Country:US
Mailing Address - Phone:512-433-9888
Mailing Address - Fax:
Practice Address - Street 1:7122 WOOD HOLLOW DR APT 3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2544
Practice Address - Country:US
Practice Address - Phone:512-433-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11518198103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst