Provider Demographics
NPI:1659105484
Name:HIGGINS, JEDEDIA (PHD, LBA/BCBA)
Entity type:Individual
Prefix:DR
First Name:JEDEDIA
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:PHD, LBA/BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8155 SAM BASS RD
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-7026
Mailing Address - Country:US
Mailing Address - Phone:405-822-7868
Mailing Address - Fax:
Practice Address - Street 1:8155 SAM BASS RD
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-7026
Practice Address - Country:US
Practice Address - Phone:405-822-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2950103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst