Provider Demographics
NPI:1770369381
Name:BUCKELEW, HAILEY (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:BUCKELEW
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 ENFIELD RD STE 306
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3431
Mailing Address - Country:US
Mailing Address - Phone:903-736-1794
Mailing Address - Fax:
Practice Address - Street 1:5700 S MOPAC EXPY
Practice Address - Street 2:STE D400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1461
Practice Address - Country:US
Practice Address - Phone:737-270-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst