Provider Demographics
NPI:1417221789
Name:HEFFERNAN, KASEY LEE (BCBA)
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:LEE
Last Name:HEFFERNAN
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 1:6202 SANDY SAGE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4687
Mailing Address - Country:US
Mailing Address - Phone:281-615-3531
Mailing Address - Fax:
Practice Address - Street 1:16107 KENSINGTON DR # 305
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4224
Practice Address - Country:US
Practice Address - Phone:281-615-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-10414103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst