Provider Demographics
NPI:1780406082
Name:HAYES, SHANNON (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 SPECTRUM DRIVE
Mailing Address - Street 2:APT 13309
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717
Mailing Address - Country:US
Mailing Address - Phone:978-998-0771
Mailing Address - Fax:
Practice Address - Street 1:1601 E PFLUGERVILLE PKWY
Practice Address - Street 2:BLDG 3, SUITE 3102
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660
Practice Address - Country:US
Practice Address - Phone:512-540-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst