Michelle Chung, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-20-46686 Issued in TX

Practice address

2401 Mustang Dr
Grapevine, TX 76051-8640

Phone

(817) 722-6118

NPI assigned

Apr 10, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediaplex Management Company LLC

  • Speech-Language Pathologist
  • Southlake, TX
  • NPI 1821374687
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1518420132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 MUSTANG DR",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760518640",
            "telephone_number": "817-722-6118",
            "fax_number": "817-442-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 MUSTANG DR",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760518640",
            "telephone_number": "817-722-6118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2425 E Southlake Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Southlake",
            "state": "TX",
            "postal_code": "760926675",
            "country_code": "US",
            "telephone_number": "817-442-0222",
            "fax_number": "817-442-0223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "MICHELLE",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-10",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "TX",
            "license": "RBT-19-82183",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "1-20-46686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Chou, DC
• Julie Christeen Chrisman-Aly, PT, DPT
• Christy Porterfield PA
• Lawton K Chu, DMD
• Wei Lu Chuang
• City of Grapevine
• Civitas Dra 2016 Managment LLC
• CKW Group, Advanced Venous Therapy
• Robert Michael Clague, PAC
• Allyssa Destiny Clancy, M.S, CCC-SLP

• Behavior Analyst in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Behavior Analyst in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.