Provider Demographics
NPI:1144977547
Name:STAFFORD, SHERYL (BCBA)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:STAFFORD
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:PO BOX 2365
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-1921
Mailing Address - Country:US
Mailing Address - Phone:830-992-8083
Mailing Address - Fax:
Practice Address - Street 1:704 SHUMARD LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-2762
Practice Address - Country:US
Practice Address - Phone:830-992-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst