Provider Demographics
NPI:1194203646
Name:HOVIOUS, MAQENZI S (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MAQENZI
Middle Name:S
Last Name:HOVIOUS
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 FOX POINTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3220
Mailing Address - Country:US
Mailing Address - Phone:812-657-3575
Mailing Address - Fax:812-657-3580
Practice Address - Street 1:2545 FOX POINTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3220
Practice Address - Country:US
Practice Address - Phone:812-657-3575
Practice Address - Fax:812-657-3580
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY243624103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300023836Medicaid