Provider Demographics
NPI:1427462571
Name:FANNIN, ABIGAIL (BCBA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:FANNIN
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 1:29423 FOX RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2497
Mailing Address - Country:US
Mailing Address - Phone:832-971-7066
Mailing Address - Fax:
Practice Address - Street 1:110 N LINTON RIDGE CT
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1441
Practice Address - Country:US
Practice Address - Phone:203-246-1346
Practice Address - Fax:203-845-8005
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137103K00000X
TX1-11-9701103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst