Provider Demographics
NPI:1932729621
Name:HEATH, HAYDEN LEE JR (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:LEE
Last Name:HEATH
Suffix:JR
Gender:M
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 1:1815 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5007
Mailing Address - Country:US
Mailing Address - Phone:540-705-6991
Mailing Address - Fax:
Practice Address - Street 1:14864 HARVEY ROAD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75706
Practice Address - Country:US
Practice Address - Phone:430-235-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3191103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-40252OtherBEHAVIOR ANALYST CERTIFICATION BOARD
TX3191OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION