Provider Demographics
NPI:1346784063
Name:ANSON, ALISHA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:ANSON
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 1:2961 N AVENIDA DE LA COLINA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9543
Mailing Address - Country:US
Mailing Address - Phone:210-632-5416
Mailing Address - Fax:
Practice Address - Street 1:7203 ARCHERS COACH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-2275
Practice Address - Country:US
Practice Address - Phone:210-632-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-24465103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst