Provider Demographics
NPI:1407441876
Name:HONAN, ALEXIS KATHRYN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:KATHRYN
Last Name:HONAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:ALEXIS
Other - Middle Name:KATHRYN
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6517 KARY LYNN DR N
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-1722
Mailing Address - Country:US
Mailing Address - Phone:585-802-5724
Mailing Address - Fax:
Practice Address - Street 1:4400 OAK PARK LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-9534
Practice Address - Country:US
Practice Address - Phone:585-802-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3962103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst