Provider Demographics
NPI:1780401836
Name:YEBOAH, ELLEN A (BCBA)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:A
Last Name:YEBOAH
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 1:3401 CALLUM DR APT 13129
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-1748
Mailing Address - Country:US
Mailing Address - Phone:647-986-3621
Mailing Address - Fax:
Practice Address - Street 1:8260 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8608
Practice Address - Country:US
Practice Address - Phone:817-717-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty