Provider Demographics
NPI:1093376683
Name:RABOLD, HEATHER ELISE (BCBA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELISE
Last Name:RABOLD
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 1:6025 SPORTS VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3505
Mailing Address - Country:US
Mailing Address - Phone:214-687-9374
Mailing Address - Fax:
Practice Address - Street 1:6025 SPORTS VILLAGE RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3505
Practice Address - Country:US
Practice Address - Phone:214-687-9374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-20-43288103K00000X
106S00000X
TX5148103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician