Provider Demographics
NPI:1902462740
Name:WEI, MISTY M (BCBA)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:M
Last Name:WEI
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 1:1213 AVIATOR LN S
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1701
Mailing Address - Country:US
Mailing Address - Phone:949-412-5939
Mailing Address - Fax:
Practice Address - Street 1:1213 AVIATOR LN S
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1701
Practice Address - Country:US
Practice Address - Phone:949-412-5939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst