Provider Demographics
NPI:1487929964
Name:TIA -CONGER, BETTY (MA, BCBA)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:TIA -CONGER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 GRANITE PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6753
Mailing Address - Country:US
Mailing Address - Phone:909-230-0749
Mailing Address - Fax:
Practice Address - Street 1:12399 LEWIS ST
Practice Address - Street 2:STE 202
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4682
Practice Address - Country:US
Practice Address - Phone:714-750-0575
Practice Address - Fax:714-750-0160
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-9058103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst