Provider Demographics
NPI:1093307944
Name:HENRY, MADISON (BCBA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-1671
Mailing Address - Country:US
Mailing Address - Phone:936-647-6028
Mailing Address - Fax:
Practice Address - Street 1:9300 JOHN HICKMAN PKWY STE 1105
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5949
Practice Address - Country:US
Practice Address - Phone:877-772-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst