Provider Demographics
NPI:1154797694
Name:WIESNER ABA LLC
Entity type:Organization
Organization Name:WIESNER ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESNER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:936-554-1616
Mailing Address - Street 1:2990 BLACKBURN ST
Mailing Address - Street 2:APT 3164
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3113
Mailing Address - Country:US
Mailing Address - Phone:936-554-1616
Mailing Address - Fax:
Practice Address - Street 1:2990 BLACKBURN ST
Practice Address - Street 2:APT 3164
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3113
Practice Address - Country:US
Practice Address - Phone:936-554-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TX251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency