Provider Demographics
NPI:1164907606
Name:HENSON, DAYREN STEPHANIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:DAYREN
Middle Name:STEPHANIE
Last Name:HENSON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 KRAMER LN APT 2303
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2808
Mailing Address - Country:US
Mailing Address - Phone:915-249-8837
Mailing Address - Fax:
Practice Address - Street 1:3000 KRAMER LN APT 2303
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2808
Practice Address - Country:US
Practice Address - Phone:915-249-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-37876103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty