Provider Demographics
NPI:1366558223
Name:HAUXWELL, ANNA KRISTINA (MA LPC, BCBA, LBA)
Entity type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:KRISTINA
Last Name:HAUXWELL
Suffix:
Gender:F
Credentials:MA LPC, BCBA, LBA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:KRISTINA
Other - Last Name:EIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 E SANILAC RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1160
Mailing Address - Country:US
Mailing Address - Phone:810-648-0330
Mailing Address - Fax:
Practice Address - Street 1:227 E SANILAC RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1160
Practice Address - Country:US
Practice Address - Phone:810-648-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009494101YP2500X
MI7401000605103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7401000605OtherBEHAVIOR ANALYST LICENSE