Provider Demographics
NPI:1194304584
Name:BONSALL, MADISON (BCBA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BONSALL
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 1:1101 ARROW POINT DR STE 305
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7740
Mailing Address - Country:US
Mailing Address - Phone:512-605-0069
Mailing Address - Fax:512-532-6160
Practice Address - Street 1:1101 ARROW POINT DR STE 305
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7740
Practice Address - Country:US
Practice Address - Phone:512-605-0069
Practice Address - Fax:512-532-6160
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-23-70349103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-20-116260OtherBEHAVIOR ANALYST CERTIFICATION BOARD