MEDICARE: NORTHERN STAR ABA, LLC

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	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1265361232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN STAR ABA, LLC

Provider Business Mailing Address
First Line	:	35 E HOBBIT GLEN DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77384-3854
Country	:	US
Telephone Number	:	832-898-8138
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 E HOBBIT GLEN DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77384-3854
Country	:	US
Telephone Number	:	832-898-8138
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	HANCHEN FANG
Credential	:	M.S., BCBA, LBA
Telephone Number	:	832-898-8138

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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