Provider Demographics
NPI:1992274328
Name:ANDERSON, KO-NISHA
Entity type:Individual
Prefix:
First Name:KO-NISHA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 W OREM DR STE 500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77085-1278
Mailing Address - Country:US
Mailing Address - Phone:832-561-8006
Mailing Address - Fax:832-218-0801
Practice Address - Street 1:5505 W OREM DR STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77085-1278
Practice Address - Country:US
Practice Address - Phone:832-561-8006
Practice Address - Fax:832-747-4583
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB351110103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst