MEDICARE: MADISON HENRY BCBA

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

General Provider Information

NPI Number	:	1093307944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON HENRY BCBA

Provider Business Mailing Address
First Line	:	809 FRANCIS AVE
Second Line	:
City	:	CELINA
State	:	TX
Zip	:	75009-1671
Country	:	US
Telephone Number	:	936-647-6028
Fax Number	:

Provider Business Practice Location Address
First Line	:	9300 JOHN HICKMAN PKWY STE 1105
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-5949
Country	:	US
Telephone Number	:	877-772-7889
Fax Number	:

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

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

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