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General NPI Number Information
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NPI Number | 1306219498
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Entity Type | Individual
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Provider Name | KRYSTAL MARIE HAUBENCHILD BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 1235 MISSION DR
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City | LEMOORE
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State | CA
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Zip | 93245-4726
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Country | US
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Telephone | 559-381-6574
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 MISSION DR
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City | LEMOORE
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State | CA
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Zip | 93245-4726
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Country | US
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Telephone | 559-381-6574
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0-15-6549
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-30559
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License Number State | CA
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