Provider Demographics
NPI:1902329014
Name:JACKSON ECHEVERRY, MAKENZIE LEIGH (BCBA)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:LEIGH
Last Name:JACKSON ECHEVERRY
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 1:23 HOSPITAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5270
Mailing Address - Country:US
Mailing Address - Phone:325-238-9337
Mailing Address - Fax:
Practice Address - Street 1:23 HOSPITAL DR STE 102
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5270
Practice Address - Country:US
Practice Address - Phone:325-793-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3669103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst