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General NPI Number Information
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NPI Number | 1932729621
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Entity Type | Individual
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Provider Name | HAYDEN LEE HEATH JR. M.S., BCBA, LBA
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Gender | Male
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 14864 HARVEY ROAD
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City | TYLER
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State | TX
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Zip | 75706
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Country | US
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Telephone | 430-235-2089
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Fax |
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Provider Business Mailing Address
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Address Line | 1815 PINECREST DR
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City | TYLER
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State | TX
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Zip | 75701-5007
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Country | US
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Telephone | 540-705-6991
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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 | 3191
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License Number State | TX
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