Provider Demographics
NPI:1386223667
Name:ANSOHN, HEATHER (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:ANSOHN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2801 OAKMONT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1021
Mailing Address - Country:US
Mailing Address - Phone:512-354-1820
Mailing Address - Fax:
Practice Address - Street 1:2801 OAKMONT DR STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1021
Practice Address - Country:US
Practice Address - Phone:512-354-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3905103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst