Provider Demographics
NPI:1396572129
Name:BOYETT, RONISHA TIA (MED,BCBA,LBA)
Entity type:Individual
Prefix:
First Name:RONISHA
Middle Name:TIA
Last Name:BOYETT
Suffix:
Gender:F
Credentials:MED,BCBA,LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 CROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-4122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1155 BRITTMOORE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-5034
Practice Address - Country:US
Practice Address - Phone:713-932-0074
Practice Address - Fax:346-348-1155
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7489103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst