Provider Demographics
NPI:1336574367
Name:HEWATT, ELIZABETH FUNK (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:FUNK
Last Name:HEWATT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DEE
Other - Last Name:FUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2703 PORTO BIANCO LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2371
Mailing Address - Country:US
Mailing Address - Phone:620-388-9102
Mailing Address - Fax:
Practice Address - Street 1:2703 PORTO BIANCO LN
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2371
Practice Address - Country:US
Practice Address - Phone:620-388-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2022-08-11
Deactivation Date:2022-07-22
Deactivation Code:
Reactivation Date:2022-08-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator