Provider Demographics
NPI:1346089257
Name:STANLEY, ELIZABETH M (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 KENNY DR
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-1333
Mailing Address - Country:US
Mailing Address - Phone:979-412-3969
Mailing Address - Fax:
Practice Address - Street 1:171 VZ COUNTY ROAD 4114
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-5651
Practice Address - Country:US
Practice Address - Phone:979-412-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-24-75934103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty