MEDICARE: MRS. HANNA KUBIN ROSSY 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	1-14-15412	TX

General Provider Information

NPI Number	:	1194135285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HANNA KUBIN ROSSY BCBA

Provider Business Mailing Address
First Line	:	1525 OXFORD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-4547
Country	:	US
Telephone Number	:	832-769-9086
Fax Number	:	888-453-4367

Provider Business Practice Location Address
First Line	:	1525 OXFORD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-4547
Country	:	US
Telephone Number	:	832-769-9086
Fax Number	:	888-453-4367

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	08/03/2016

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