Provider Demographics
NPI:1073146965
Name:AYSHA, HANEEN
Entity Type:Individual
Prefix:
First Name:HANEEN
Middle Name:
Last Name:AYSHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6448 E HWY 290 STE C104
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1039
Mailing Address - Country:US
Mailing Address - Phone:512-368-9488
Mailing Address - Fax:
Practice Address - Street 1:6448 E HWY 290 STE C104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1039
Practice Address - Country:US
Practice Address - Phone:512-368-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician