Provider Demographics
NPI:1689284283
Name:ERICKSON, STEFFANI ELISE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:STEFFANI
Middle Name:ELISE
Last Name:ERICKSON
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 1:3915 W DAVIS ST # 130216
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1878
Mailing Address - Country:US
Mailing Address - Phone:936-283-0449
Mailing Address - Fax:
Practice Address - Street 1:3915 W DAVIS ST # 130216
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1878
Practice Address - Country:US
Practice Address - Phone:936-283-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3304103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst