Provider Demographics
NPI:1598591455
Name:MADISE, NIA (BCBA)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:MADISE
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 1:4920 MAGNOLIA COVE DR APT 3307
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2249
Mailing Address - Country:US
Mailing Address - Phone:985-255-2119
Mailing Address - Fax:
Practice Address - Street 1:2045 SPRING STUEBNER RD STE 600
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-4812
Practice Address - Country:US
Practice Address - Phone:817-562-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst