Provider Demographics
NPI:1417254939
Name:JOSE NEMAZANNIKOVA, ELENA (MS BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:
Last Name:JOSE NEMAZANNIKOVA
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2287 AZAHAR CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3299
Mailing Address - Country:US
Mailing Address - Phone:347-733-2596
Mailing Address - Fax:
Practice Address - Street 1:4600 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3335
Practice Address - Country:US
Practice Address - Phone:281-310-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2837103K00000X
TX1-19-34414103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88-2127689OtherABA THERAPY