Healthcare Provider Details

I. General information

NPI: 1407327042
Provider Name (Legal Business Name): HANNAH MAY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 E 70TH ST
SHREVEPORT LA
71105-4002
US

IV. Provider business mailing address

911 N GOLIAD ST
ROCKWALL TX
75087-2230
US

V. Phone/Fax

Practice location:
  • Phone: 318-795-3388
  • Fax:
Mailing address:
  • Phone: 469-458-9021
  • Fax: 866-693-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-46123
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-68249
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: