Provider Demographics
NPI:1164029633
Name:HANES, JOSHUA (BCBA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HANES
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 COLLEYVILLE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6236
Mailing Address - Country:US
Mailing Address - Phone:817-952-8917
Mailing Address - Fax:
Practice Address - Street 1:2417 PRESIDIO VISTA DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8275
Practice Address - Country:US
Practice Address - Phone:682-316-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB611594103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBACB611594OtherBCBA
TXRBT-20-138412OtherRBT