Provider Demographics
NPI:1659135002
Name:EHIEMUA, ROXANNE (RBT)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:EHIEMUA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20942 BLOOMING SHRUBS CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2511
Mailing Address - Country:US
Mailing Address - Phone:281-770-2508
Mailing Address - Fax:
Practice Address - Street 1:10242 GREENHOUSE RD STE 401
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1827
Practice Address - Country:US
Practice Address - Phone:281-758-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician