Provider Demographics
NPI:1306180211
Name:HOUSEWORTH, HAL (BCBA)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:
Last Name:HOUSEWORTH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 S CLIFF SWALLOW CT
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-0849
Mailing Address - Country:US
Mailing Address - Phone:937-545-2763
Mailing Address - Fax:
Practice Address - Street 1:5963 KENTSHIRE DR # A
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-4253
Practice Address - Country:US
Practice Address - Phone:937-545-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10444103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst