Provider Demographics
NPI:1699280040
Name:BONNSTETTER, LISSA (BCBA)
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:
Last Name:BONNSTETTER
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 1:6717 KEMPER DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-1013
Mailing Address - Country:US
Mailing Address - Phone:972-207-3734
Mailing Address - Fax:
Practice Address - Street 1:6717 KEMPER DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-1013
Practice Address - Country:US
Practice Address - Phone:972-207-3734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-19-35365103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst