MEDICARE: MRS. HANNAH ELIZABETH BOHANNON 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	1-17-28679	TX

General Provider Information

NPI Number	:	1477061828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HANNAH ELIZABETH BOHANNON BCBA

Provider Business Mailing Address
First Line	:	611 ROCKMEAD DR STE 100
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2294
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 ROCKMEAD DR STE 100
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2294
Country	:	US
Telephone Number	:	281-713-8980
Fax Number	:

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

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	01/19/2018

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Directions to “ MRS. HANNAH ELIZABETH BOHANNON BCBA” Practice Location

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