MEDICARE: MRS. LISE K NEW BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	6942	TX

General Provider Information

NPI Number	:	1447007364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISE K NEW BCBA, LBA

Provider Business Mailing Address
First Line	:	17731 SEED DRILL LN
Second Line	:
City	:	HOCKLEY
State	:	TX
Zip	:	77447-2415
Country	:	US
Telephone Number	:	210-842-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 MITCHELLDALE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-7231
Country	:	US
Telephone Number	:	281-715-2888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	02/17/2026

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