Provider Demographics
NPI:1912663964
Name:KLIEWER, ANITA JO (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:JO
Last Name:KLIEWER
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:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-0741
Mailing Address - Country:US
Mailing Address - Phone:903-819-1285
Mailing Address - Fax:
Practice Address - Street 1:1303 N ELM ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3019
Practice Address - Country:US
Practice Address - Phone:940-369-0482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2020103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst