Provider Demographics
NPI:1457859332
Name:WEILER, MARISSA ANN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANN
Last Name:WEILER
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13581 POND SPRINGS RD STE 125
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-4434
Mailing Address - Country:US
Mailing Address - Phone:512-688-8530
Mailing Address - Fax:
Practice Address - Street 1:13581 POND SPRINGS RD STE 125
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-4434
Practice Address - Country:US
Practice Address - Phone:512-688-8530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5103106S00000X
TX3994103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician